The Experts below are selected from a list of 300 Experts worldwide ranked by ideXlab platform
Louis R. Caplan - One of the best experts on this subject based on the ideXlab platform.
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Vertebral Artery Compression Syndrome.
Frontiers in neurology, 2019Co-Authors: Peng Xie, Wen-song Yang, Bernard Yan, Stephen M. Davis, Louis R. CaplanAbstract:Objective: We aim to propose the term "Vertebral Artery compression syndrome" to describe a group of patients with a variety of clinical symptoms caused by Vertebral Artery compression of the medulla or spinal cord. Methods: We conducted the prospective case study in a university teaching hospital. Eleven patients who fulfilled the diagnostic criteria of Vertebral Artery compression syndrome and 22 age- and sex- matched controls were recruited. Clinical presentation and radiological findings of patients with Vertebral Artery compression syndrome were assessed and recorded. The basilar Artery diameter was measured at the midpons level on T2 weighted MR images and compared between both groups. Results: Medullary compression was observed in 10 of 11 patients. The most common clinical presentation is dizziness, vertigo, imbalance, or ataxia followed by limb weakness. Cervical spinal cord compression was observed in one patient who presented with neck pain and left leg weakness. The mean basilar Artery diameter was similar between patients and controls (3.95 ± 0.41 vs. 3.81 ± 0.43 mm). Conclusions: Vertebral Artery compression of medulla and spinal cord may cause various clinical symptoms. Future studies are needed to further clarify the prevalence, natural history and treatment of this condition.
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Atherosclerotic Vertebral Artery disease in the neck
Current Treatment Options in Cardiovascular Medicine, 2003Co-Authors: Louis R. CaplanAbstract:Atherosclerotic lesions are very common at the origin and first few centimeters of the Vertebral Artery in the neck. These lesions are often missed when using noninvasive diagnostic strategies. These lesions cause transient hypoperfusion and transient ischemic attacks, characterized mostly by vestibulocerebellar symptoms. Strokes are caused by embolism from these lesions. Patients with nonstenosing Vertebral Artery plaques should be treated with statins and antiplatelet agents. Symptomatic patients who have had embolism from an occluded Vertebral Artery should be treated with heparin followed by warfarin for a period of 4 to 12 weeks. Antiplatelet agents can then be given. The optimal treatment of asymptomatic and symptomatic patients with severe Vertebral Artery stenosis is unclear. Statins and warfarin are recommended for patients with concurrent stenotic lesions of the contralateral extracranial Vertebral Artery, the intracranial Vertebral or basilar arteries, or the anterior circulation arteries. Balloon angioplasty or stenting will likely prove superior to surgery in those patients with severe stenosis who do not respond to medical treatment.
Daniel C. Brooks - One of the best experts on this subject based on the ideXlab platform.
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Vertebral Artery Stenosis
Current Treatment Options in Cardiovascular Medicine, 2020Co-Authors: Daniel C. Brooks, Joseph SchindlerAbstract:Vertebral Artery stenosis is a common condition associated with a very high risk of stroke. The goal of this review is to summarize the pathophysiology and natural history of Vertebral Artery stenosis and to evaluate the efficacy of medical and endovascular therapies. Early and aggressive initiation of medical care combined with advancements in antithrombotic and lipid-lowering therapies has substantially reduced the risk of stroke due to Vertebral Artery stenosis. Endovascular therapy does not appear to be beneficial with extracranial Vertebral Artery stenosis and appears harmful with intracranial Vertebral Artery stenosis. Risk of stroke due to symptomatic Vertebral Artery stenosis can be significantly reduced with implementation of standardized best medical therapy protocols focusing on ultra-early dual antiplatelet therapy, high-intensity statin therapy + novel lipid-lowering agents, and aggressive risk factor control. Endovascular therapy with angioplasty and stenting is not likely to play a significant role in treatment.
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Vertebral Artery Stenosis
Current Treatment Options in Cardiovascular Medicine, 2020Co-Authors: Daniel C. Brooks, Joseph L. SchindlerAbstract:Purpose of review Vertebral Artery stenosis is a common condition associated with a very high risk of stroke. The goal of this review is to summarize the pathophysiology and natural history of Vertebral Artery stenosis and to evaluate the efficacy of medical and endovascular therapies. Recent findings Early and aggressive initiation of medical care combined with advancements in antithrombotic and lipid-lowering therapies has substantially reduced the risk of stroke due to Vertebral Artery stenosis. Endovascular therapy does not appear to be beneficial with extracranial Vertebral Artery stenosis and appears harmful with intracranial Vertebral Artery stenosis. Summary Risk of stroke due to symptomatic Vertebral Artery stenosis can be significantly reduced with implementation of standardized best medical therapy protocols focusing on ultra-early dual antiplatelet therapy, high-intensity statin therapy + novel lipid-lowering agents, and aggressive risk factor control. Endovascular therapy with angioplasty and stenting is not likely to play a significant role in treatment.
Gregory D. Schroeder - One of the best experts on this subject based on the ideXlab platform.
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Vertebral Artery injuries in cervical spine surgery.
Surgical neurology international, 2013Co-Authors: Gregory D. SchroederAbstract:Vertebral Artery injuries during cervical spine surgery are rare, but potentially fatal. When performing cervical spine surgery, it is imperative that the surgeon has a systematic approach for avoiding, and if necessary, dealing with a Vertebral Artery injury. This is a review paper. Upper posterior cervical spine surgeries put the Vertebral Artery at the highest risk, as opposed to anterior subaxial cervical spine procedures, which put the Artery at the least risk. A thorough understanding of the complex anatomy of the Vertebral Artery is mandatory prior to performing cervical spine surgery, and since the Vertebral Artery can have a variable course, especially in the upper cervical spine, the surgeon must minimize the possibility of an arterial injury by preoperatively assessing the Artery with a computed tomography (CT) scan or magnetic resonance imaging (MRI). Intraoperatively, the surgeon must be aware of when the Vertebral Artery is most at risk, and take precautions to avoid an injury. In the event of an arterial injury, the surgeon must have a plan of action to (1) Achieve control of the hemorrhage. (2) Prevent acute central nervous system ischemia. (3) Prevent postoperative complications such as embolism and pseudoaneurysm. Prior to performing cervical spine surgery, one must understand the four A's of Vertebral Artery injuries: Anatomy, Assessment, Avoidance, and Action.
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Vertebral Artery injuries in cervical spine surgery
Surgical Neurology International, 2013Co-Authors: Gregory D. SchroederAbstract:Background: Vertebral Artery injuries during cervical spine surgery are rare, but potentially fatal. When performing cervical spine surgery, it is imperative that the surgeon has a systematic approach for avoiding, and if necessary, dealing with a Vertebral Artery injury. Methods: This is a review paper. Results: Upper posterior cervical spine surgeries put the Vertebral Artery at the highest risk, as opposed to anterior subaxial cervical spine procedures, which put the Artery at the least risk. A thorough understanding of the complex anatomy of the Vertebral Artery is mandatory prior to performing cervical spine surgery, and since the Vertebral Artery can have a variable course, especially in the upper cervical spine, the surgeon must minimize the possibility of an arterial injury by preoperatively assessing the Artery with a computed tomography (CT) scan or magnetic resonance imaging (MRI). Intraoperatively, the surgeon must be aware of when the Vertebral Artery is most at risk, and take precautions to avoid an injury. In the event of an arterial injury, the surgeon must have a plan of action to (1) Achieve control of the hemorrhage. (2) Prevent acute central nervous system ischemia. (3) Prevent postoperative complications such as embolism and pseudoaneurysm Conclusion: Prior to performing cervical spine surgery, one must understand the four A's of Vertebral Artery injuries: Anatomy, Assessment, Avoidance, and Action.
Patrick Corr - One of the best experts on this subject based on the ideXlab platform.
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Vertebral Artery injury in cervical spine trauma
Injury-international Journal of The Care of The Injured, 2001Co-Authors: A.h. Parbhoo, Sumen Govender, Patrick CorrAbstract:Forty-seven patients with cervical spine trauma were evaluated prospectively with magnetic resonance imaging (MRI) and angiography (MRA) to determine the incidence of Vertebral Artery injury. Twelve patients (25%) had Vertebral Artery injuries (one bilateral), and occlusion was identified in nine patients and dissection in four. The Vertebral Artery injury did not result in neurological dysfunction. No specific treatment was instituted for the vascular injury, and in four patients, MRA showed no evidence of recanalization at follow-up.
Kazuhito Matsuzawa - One of the best experts on this subject based on the ideXlab platform.
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Occipital Artery-to-Vertebral Artery Bypass to Stop Transient Ischemic Attacks Caused by Traumatic Vertebral Artery Dissection.
World neurosurgery, 2018Co-Authors: Yasuaki Inoue, Kazuhito MatsuzawaAbstract:Background Ischemic symptoms caused by traumatic Vertebral Artery dissection after cervical maneuvers are treated medically and surgically. This is a report of the infrequently documented occipital to Vertebral Artery bypass to stop the transient ischemic attacks following traumatic Vertebral Artery dissection. Case Description A 33-year-old man presented with a sudden right posterior neck pain following a sudden neck movement, accompanied by left lower quadrant anopsia and rotational vertigo. The neurologic symptoms had already been resolved on arrival. Magnetic resonance imaging and digital subtraction angiography revealed an extracranial Vertebral Artery dissection with no evidence of cerebral infarction. Although medical therapy was initiated, he repeatedly complained of ischemic symptoms. A bypass was performed from the occipital Artery to the atlas loop of the Vertebral Artery with distal occlusion of the lesion. The patient was neurologically intact after the surgery, and magnetic resonance imaging showed no cerebral infarction. Conclusion A bypass from the occipital Artery to the atlas loop of the Vertebral Artery is an effective procedure for traumatic extracranial Vertebral Artery dissection with ischemic symptoms.
