Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Neuroradiology
Published in: Neuroradiology 5/2013

01-05-2013 | Diagnostic Neuroradiology

Variations in the origin of the vertebral artery and its level of entry into the transverse foramen diagnosed by CT angiography

Authors: Akira Uchino, Naoko Saito, Masahiro Takahashi, Yoshitaka Okada, Eito Kozawa, Naoko Nishi, Waka Mizukoshi, Reiko Nakajima, Yusuke Watanabe

Published in: Neuroradiology | Issue 5/2013

Login to get access

Abstract

Introduction

The origin of the vertebral artery (VA) varies, though most VAs enter the transverse foramen (TF) of the sixth cervical vertebra. On computed tomography (CT) angiographic images, we evaluated the prevalence of variations of both VA origin and its level of entry into the TF.

Methods

We retrospectively reviewed CT angiographic images of 2,287 patients obtained using either of two 64-slice multidetector CT scanners. All patients were Japanese and underwent scanning from the aortic arch to the intracranial region; most had or were suspected of having cerebrovascular diseases.

Results

The left VA (LVA) arose from the aorta between the left common carotid artery and left subclavian artery in 94 patients (4.1 %) and in other variations in 44 patients (1.9 %). The right VA (RVA) arose from the extreme proximal segment of the right subclavian artery in 72 patients (3.1 %) and in other variations in 14 patients (0.6 %). The LVA entered the sixth TF in 2,127 patients (93.0 %), and the RVA entered the sixth TF in 2,146 patients (93.8 %). Anomalous origin and anomalous entry level into the TF correlated strongly.

Conclusions

The total prevalence of variation in the origin of the LVA was 6.0 % and of the RVA, 3.8 %. The total prevalence of variation in entry level into the TF was 7.0 % for the LVA and 6.2 % for the RVA. Recognition and reporting of these variations is important in interpreting CT angiography to prevent complications during surgery of the aortic arch or lower neck.
Literature
1.
Adachi B (1928) Das arteriensystem der Japaner, vol 1. Maruzen, Kyoto, pp 138–155
2.
Berko NS, Jain VR, Godelman A, Stein EG, Ghosh S, Haramati LB (2009) Variants and anomalies of thoracic vasculature on computed tomographic angiography in adults. J Comput Assist Tomogr 33:523–528PubMedCrossRef
3.
Jakanani GC, Adair W (2010) Frequency of variations in aortic arch anatomy depicted on multidetector CT. Clin Radiol 65:481–487PubMedCrossRef
4.
Müller M, Schmitz BL, Pauls S, Schick M, Röhrer S, Kapapa T, Schlötzer W (2011) Variations of the aortic arch—a study on the most common branching patterns. Acta Radiol 52:738–742PubMedCrossRef
5.
Koenigsberg RA, Pereira L, Nair B, McCormick D, Schwartzman R (2003) Unusual vertebral artery origins: examples and related pathology. Catheter Cardiovasc Interv 59:244–250PubMedCrossRef
6.
Goray VB, Joshi AR, Garg A, Merchant S, Yadav B, Maheshwari P (2005) Aortic arch variation: a unique case with anomalous origin of both vertebral arteries as additional branches of the aortic arch distal to left subclavian artery. AJNR Am J Neuroradiol 26:93–95PubMed
7.
Hsu DP, Alexander AD, Gilkeson RC (2010) Anomalous vertebral artery origins: the first and second reports of two variants. J Neurointervent Surg 2:160–162CrossRef
8.
Yamashiro S, Kuniyoshi Y, Arakaki K, Inafuku H, Morishima Y, Kise Y (2010) Total arch replacement with associated anomaly of the left vertebral artery. Ann Thorac Cardiovasc Surg 16:216–219PubMed
9.
Kiss J (1968) Bifid origin of the right vertebral artery: a case report. Radiology 91:931PubMed
10.
Suzuki S, Kuwabara Y, Hatano R, Iwai T (1978) Duplicate origin of left vertebral artery. Neuroradiology 15:27–29PubMedCrossRef
11.
Nishijima M, Harada J, Akai T, Endo S, Takaku A (1989) Operative correction of a kinked duplicate origin of the vertebral artery in a patient with dizziness. Case report. Surg Neurol 32:356–359PubMedCrossRef
12.
Nogueira TE, Chambers AA, Brueggemeyer MT, Miller TJ (1997) Dual origin of the vertebral artery mimicking dissection. AJNR Am J Neuroradiol 18:382–384PubMed
13.
Kimura K, Yonemitsu M, Hashimoto Y, Uchino M (1997) Spontaneous dissection associated with proximal vertebral artery anomaly. Intern Med 36:834–836PubMedCrossRef
14.
Goddard AJ, Annesley-Williams D, Guthrie JA, Weston M (2001) Duplication of the vertebral artery: report of two cases and review of the literature. Neuroradiology 43:477–480PubMedCrossRef
15.
Ionete C, Omojola MF (2006) MR angiographic demonstration of bilateral duplication of the extracranial vertebral artery: unusual course and review of the literature. AJNR Am J Neuroradiol 27:1304–1306PubMed
16.
Satti SR, Cerniglia CA, Koenigsberg RA (2007) Cervical vertebral artery variations: an anatomic study. AJNR Am J Neuroradiol 28:976–980PubMed
17.
Lemke AJ, Benndorf G, Liebig T, Felix R (1999) Anomalous origin of the right vertebral artery: review of the literature and case report of right vertebral artery origin distal to the left subclavian artery. AJNR Am J Neuroradiol 20:1318–1321PubMed
18.
Karcaaltincaba M, Strottman J, Washington L (2003) Multidetector-row CT angiographic findings in the bilateral aortic arch origin of the vertebral arteries. AJNR Am J Neuroradiol 24:157PubMed
19.
Al-Okaili R, Schwartz ED (2007) Bilateral aortic origins of the vertebral arteries with right vertebral artery arising distal to left subclavian artery: case report. Surg Neurol 67:174–176PubMedCrossRef
20.
Kau TK, Gasser J, Lesnik G, Sinzig M, Hausegger KA (2008) Images in vascular medicine. Two exceptionally rare branching patterns of the aortic arch. Vasc Med 13:89–90PubMedCrossRef
21.
Karcaaltincaba M, Haliloglu M, Ozkan E, Kocak M, Akinci D, Ariyurek M (2009) Non-invasive imaging of aberrant right subclavian artery pathologies and aberrant right vertebral artery. Br J Radiol 82:73–78PubMedCrossRef
22.
Canyigit M, Akgoz A, Koksal A, Yucesoy C (2009) Aberrant right vertebral artery: a rare aortic arch anomaly. Br J Radiol 82:789–791PubMedCrossRef
23.
Verin AL, Creuze N, Musset D (2010) Multidetector CT scan findings of a right aberrant retroesophageal vertebral artery with an anomalous origin from a cervical aortic arch. Chest 138:418–422PubMedCrossRef
24.
Dabus G, Walker MT (2010) Right vertebral artery arising from the aortic arch distal to the left subclavian artery diagnosed with magnetic resonance angiography. Arch Neurol 67:508PubMedCrossRef
25.
Lacout A, Khalil A, Figl A, Liloku R, Marcy PY (2012) Vertebral arteria lusoria: a life-threatening condition for oesophageal surgery. Surg Radiol Anat 34:381–383PubMedCrossRef
26.
Edwards JE (1948) Anomalies of the derivatives of the aortic arch system. Med Clin North Am 32:925–949PubMed
27.
Daseler EH, Anson BJ (1959) Surgical anatomy of the subclavian artery and its branches. Surg Gynecol Obstet 108:149–174PubMed
28.
Argenson C, Francke JP, Sylla S, Dintimille H, Papasian S, di Marino V (1980) The vertebral arteries (segments V1 and V2). Anat Clin 2:29–41CrossRef
29.
Matula C, Trattnig S, Tschabitscher M, Day JD, Koos WT (1997) The course of the prevertebral segment of the vertebral artery: anatomy and clinical significance. Surg Neurol 48:125–131PubMedCrossRef
30.
Giuffrè R, Sherkat S (1999) The vertebral artery: developmental pathology. J Neurosurg Sci 43:175–189PubMed
31.
Padget DH (1948) The development of the cranial arteries in the human embryo. Contrib Embryol 32:207–261
32.
33.
Ka-Tak W, Lam WW, Yu SC (2007) MDCT of an aberrant right subclavian artery and of bilateral vertebral arteries with anomalous origins. AJR Am J Roentgenol 188:W274–W275PubMedCrossRef
34.
Wang K, Zhang M, Sun J, Zhao S (2011) A right-left aortic arch pattern made up by a bicarotid trunk, a left subclavian, a left vertebral and a right retroesophageal subclavian artery. Surg Radiol Anat 33:937–940PubMedCrossRef
35.
Wasserman BA, Mikulis DJ, Manzione JV (1992) Origin of the right vertebral artery from the left side of the aortic arch proximal to the origin of the left subclavian artery. AJNR Am J Neuroradiol 13:355–358PubMed
36.
Albayram S, Gailloud P, Wasserman BA (2002) Bilateral arch origin of the vertebral arteries. AJNR Am J Neuroradiol 23:455–458PubMed
37.
Akdeniz B, Yilmaz E, Pekel N, Ergul BU (2007) Anomalous origin of the right vertebral artery from the ascending aorta in the presence of an aberrant right subclavian artery. Int J Cardiovasc Imaging 23:39–42PubMedCrossRef
38.
Fujiyama K, Motomura M, Shirabe S, Nakamura T, Isomoto I, Shibayama K, Nagasato K, Yoshimura T, Tsujihata M, Nagataki S (1994) Locked-in syndrome and abnormal orientation of the right vertebral artery in a young man. Intern Med 33:476–480PubMedCrossRef
39.
Jackson RS, Wheeler AH, 2nd Darden BV (2000) Vertebral artery anomaly with atraumatic dissection causing thromboembolic ischemia: a case report. Spine (Phila PA 1976) 25:1989–1992CrossRef
Metadata
Title
Variations in the origin of the vertebral artery and its level of entry into the transverse foramen diagnosed by CT angiography
Authors
Akira Uchino
Naoko Saito
Masahiro Takahashi
Yoshitaka Okada
Eito Kozawa
Naoko Nishi
Waka Mizukoshi
Reiko Nakajima
Yusuke Watanabe
Publication date
01-05-2013
Publisher
Springer-Verlag
Published in
Neuroradiology / Issue 5/2013
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI
https://doi.org/10.1007/s00234-013-1142-0

Other articles of this Issue 5/2013

Neuroradiology 5/2013 Go to the issue

Head and Neck Radiology

Characterization and therapy monitoring of head and neck carcinomas using diffusion-imaging-based intravoxel incoherent motion parameters—preliminary results

EDITORIAL

Are we ready to image the incoherent molecular motion in our minds?

Diagnostic Neuroradiology

Utility of multiparametric 3-T MRI for glioma characterization

Paediatric Neuroradiology

Arterial spin labelling MRI for assessment of cerebral perfusion in children with moyamoya disease: comparison with dynamic susceptibility contrast MRI

Interventional Neuroradiology

Stent-assisted coil embolization of intracranial aneurysms using the Solitaire™ AB Neurovascular Remodeling Device: initial and midterm follow-up results

Diagnostic Neuroradiology

Diffusion tensor imaging and brain volumetry in Fabry disease patients