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AJNR - American Journal of Neuroradiology

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Anterior Spinal Artery as a Collateral Channel in Cases of Bilateral Vertebral Arterial Steno-Occlusive Diseases

H.-S. Kang^a, M.H. Han^c, S.H. Kim^c, O.-K. Kwon^d, H.G. Roh^b and Y.C. Ko^a

^a Department of Neurosurgery, Konkuk University Hospital, Seoul, Korea
^b Department of Radiology, Konkuk University Hospital, Seoul, Korea
^c Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
^d Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea

View larger version (39K): [in this window] [in a new window]   Fig 1. Left vertebral angiograms in anteroposterior (A and C) and lateral (B and D) views show the occluded vertebral artery (VA) and retrograde upward flow through the anterior spinal artery (ASA) at early arterial (A and B) and later (C and D) phases in patient 1. The ASA is connected to the right distal VA and supplies the right anterior and posterior inferior cerebellar arteries.

View larger version (47K): [in this window] [in a new window]   Fig 2. Left vertebral angiograms in anteroposterior (AP) (A) and lateral (B) views show the anterior spinal artery (ASA; arrow) filled in retrograde direction as well as the occluded VA in patient 3, though it is not clear that the ASA is providing any significant collateral support to the posterior circulation. Left common carotid angiograms in AP (C) and lateral (D) views reveal contrast filling of the basilar artery from the posterior communicating artery. Diffuse severe arteriosclerotic narrowing and dilation of cerebral arteries is also noted.

View larger version (48K): [in this window] [in a new window]   Fig 3. Right vertebral angiograms in lateral views (A and B) demonstrate the occluded vertebral artery (VA) and retrograde flow through the anterior spinal artery (ASA) and perfusion to pontine perforators after filling of the basilar artery at later phase (B, arrow) in patient 2. Angiograms in right anterior oblique view at early arterial (C) and later (D) phases reveals reversal (normalization) of blood flow through the ASA after successful stent-assisted recanalization of the right VA.

View larger version (60K): [in this window] [in a new window]   Fig 4. Irregular stenosis of the left vertebral artery (VA) is shown on the left vertebral angiograms in anteroposterior (AP) (A) and lateral (B) views in patient 5. Severe stenosis of the left posterior inferior cerebral artery (PICA) orifice is also noted (arrow). Right vertebral angiogram in the lateral view shows retrograde flow through the anterior spinal artery (ASA) (C). There is minimal perfusion to right distal VA. Follow-up angiography after 9 months shows increased perfusion through the ASA at early arterial (D) and later (E) phases. Both distal VAs are connected to the ASA, and perfusion to the common trunk of the right anterior interior cerebellar artery (AICA) and PICA and left AICA is maintained by this collateral route. The left VA was completely occluded (not shown).