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Case Reports
. 2018 Dec 31;5(1):14-17.
doi: 10.1016/j.jvscit.2018.09.006. eCollection 2019 Mar.

Rotational vertebral artery occlusion secondary to completely extraosseous vertebral artery

Rachel Rendon  1   2 , Kristyn Mannoia  3 , Steven Reiman  4   5 , Louise Hitchman  6 , William Shutze  2   4
Affiliations
Case Reports

Rotational vertebral artery occlusion secondary to completely extraosseous vertebral artery

Rachel Rendon et al. J Vasc Surg Cases Innov Tech. .

Abstract

Rotational vertebral artery (VA) occlusion is a possible cause of reduced blood flow through the posterior circulation of the brain due to compression of the VA on head turning when blood flow from the contralateral VA is compromised. When compression occurs in the V2 segment of the VA, it is usually due to compression from the longus colli muscle or cervical osteophytes. We present a unique case of a patient with a completely extraosseous course of the V2 segment of her dominant right VA that resulted in symptomatic rotational VA occlusion.

Keywords: Compression; Syncope; Vertebral artery; Vertebrobasilar insufficiency.

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Figures

Fig 1
Fig 1
Preoperative computed tomography angiography (CTA) demonstrates extrinsic compression of the extraosseous V2 segment of the right vertebral artery (VA). The yellow arrow points to the posterior superior projection of the thyroid cartilage. The green arrow demonstrates extrinsic compression of the right VA by the posterior superior projection of the thyroid cartilage.
Fig 2
Fig 2
The yellow arrow points to the extraosseous right vertebral artery (VA) and the green arrow shows the levator scapulae muscle coursing anterior to and compressing the VA. The black arrow points to the posterior carotid sheath being retracted with stay sutures. The patient's head is in a neutral position.
Fig 3
Fig 3
The extraosseous V2 segment of the right vertebral artery (VA) is demonstrated by the yellow arrow. The green arrow points to the posterior superior projection of the right thyroid cartilage. The area of extrinsic compression of the right VA is circled in white.
Fig 4
Fig 4
Comparison of the preoperative (A) and postoperative (B) volume rendered computed tomography angiograms of the vertebral artery (VA; arrows) demonstrates that segmental removal of the thyroid cartilage has resolved the rotationally induced compression.
See this image and copyright information in PMC

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