Related Experiment Videos
[Occlusion of the vertebral artery (100 personal cases)]
R Labauge1, M Boukobza, M Pagès
1Clinique Neurologique, C.H.U. Gui de Chauliac, Montpellier.
Insights
Vertebral artery occlusion, often from atherosclerosis, carries a significant mortality risk (25%). Treatment is typically symptomatic, though surgery for proximal occlusion may prevent further issues.
Area of Science:
- Neurology
- Vascular Surgery
- Radiology
Background:
- Vertebral artery occlusion is primarily caused by atherosclerosis.
- Lesions present in segmental, multisegmental, or extensive patterns.
- Associated infarctions typically affect cerebellar lobes and the lateral medulla.
Purpose of the Study:
- To classify clinico-pathologico-angiographic situations of vertebral artery occlusion.
- To analyze clinical manifestations, including stroke syndromes and headache.
- To assess the mortality risk and evaluate treatment strategies.
Main Methods:
- Review of 160 cases (100 personal).
- Angiography and Doppler examinations to identify arterial lesions and hemodynamic disturbances.
- Clinical and pathological correlation of occlusion sites with neurological deficits.
Main Results:
- Three main occlusion patterns identified: segmental (V1, V3, V4), multisegmental (V1-V2), and extensive (V1, V4).
- Common clinical presentations include cerebellar, vestibular, or cerebello-vestibular strokes, and Wallenberg's syndrome, often preceded by occipito-cervical headache.
- Mortality rate was 25%, with higher risk in distal segmental and extensive occlusions compared to proximal ones.
Conclusions:
- Vertebral artery occlusion poses a non-negligible vital risk.
- Proximal segmental occlusions, when compensated, are less critical than distal or extensive occlusions.
- Symptomatic treatment is common, but surgery for proximal vertebral artery occlusion can be life-saving.
Abstract:
Occlusion of the vertebral artery is usually due to atherosclerosis. According to the site and extension of the arterial lesions 3 clinico-pathologico-angiographic situations can be encountered: segmental occlusion (proximal: V1 or distal: V3, V4), multisegmental (mainly V1-V2, sometimes V1-V2-V3) or extensive (V1 or V4). Subsequent infarctions are localized in ipsilateral cerebellar lobes and ipsilateral lateral part of the medulla oblongata; supra-medullary involvement is rare and indicates a propagation of the vertebral thrombus into the basilar artery. Cerebellar, vestibular or cerebello-vestibular strokes and Wallenberg's syndrome are the more frequent clinical disorders. They are often preceded by occipito-cervical headache. Contrary to a common belief, the vital risk in vertebral artery occlusion is not negligible. Among 160 cases, 100 of which are personal, mortality was 25%. In fact benign segmental and proximal occlusion adequately compensated, specially when isolated, must be opposed to segmental distal occlusion and extensive occlusion. Angiography and Döppler examinations localize arterial lesions and subsequent hemodynamic disorders. The treatment is often symptomatic only. Surgery of the proximal vertebral artery may in some cases be the only hope of preventing occlusion.