Vertebral Artery

Question 1

> 90% of hemodynamically significant lesions occur at ______

Answer 1

Origin

Question 2

Vetebral variant

Answer 2

Left vertebral originates from aorta in 3-5%

Question 3

Landmark

Answer 3

Transverse processes of cervical spine.

Question 4

Vertebral artery flow

Answer 4

Low resistant. Low PSV 20-60cm/s

Accelerated patterns in:
•dominant vertebral artery
•compensation (occluded ipsilateral ICA or contralateral vertebral artery)
•compression

Question 5

Subclavian Steel

Answer 5

Flow reversal.
Bidirectional. PSV flow reversed, antegrade flow in diastoli.

90% on left side.

Blood is stolen from the brain by the vertebral artery when there is a high grade stenosis in the subclavian or Innominate artery.

If see subclavian Steele on right, must determine source. Subclavian vs Innominate.

If blockage is in Innominate artery, has significant effect in Rt CCA and Rt vertebral.

Pulse and blood pressures will be decreased in affected arm.

Question 6

Treatment

Answer 6

Vertebral eatery reconstruction
•Bypass
•Transposition

Endarterectomy. Open and clean out carotid

Stent placement

Question 7

Pt that passes out when tilts head may have

Answer 7

Bilateral ICA occlusion. Vertebral arteries are compensating. Every time patient tilts head back, he interrupts flow from vertebral arteries.