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Table of Contents    
NEUROIMAGES
Year : 2017  |  Volume : 65  |  Issue : 3  |  Page : 679-680

Duplicated origin of vertebral artery


1 Department of Neurology, Charleston Area Medical Center, Charleston, United States
2 Department of Neurology, Neurovascular Imaging Research Core, University of California, Los Angeles, United States

Date of Web Publication9-May-2017

Correspondence Address:
Konark Malhotra
Department of Neurology, Charleston Area Medical Center, Charleston
United States
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/neuroindia.NI_1080_16

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How to cite this article:
Malhotra K, Liebeskind DS. Duplicated origin of vertebral artery. Neurol India 2017;65:679-80

How to cite this URL:
Malhotra K, Liebeskind DS. Duplicated origin of vertebral artery. Neurol India [serial online] 2017 [cited 2017 Sep 24];65:679-80. Available from: http://www.neurologyindia.com/text.asp?2017/65/3/679/205884


Sir,

Anatomical vascular variants are usually related as incidental findings on angiographic images. Presence of these variations carries significance during invasive and non-invasive procedures. Vertebral arteries (VAs) originate from the subclavian artery, though anomalous origin of VA directly from the aortic arch can rarely occur in ~5% of cases.[1] Embryologically, VAs arise from the anastomosis of cervical intersegmental branches; however, persistence of these branches tend to predispose to anomalous variants. All cervical segments eventually regress, except the seventh branch that give rise to subclavian and vertebral arteries. Rarely, the fifth cervical branch fails to regress and tends to fuse with the seventh cervical branch, leading to VA duplication.

Anomalous origin of vertebral artery is speculated to cause hemodynamic alterations and lead to intracranial malformations.[2] Duplication of VA is rare and 36 cases have been reported so far.[3] However, a total of 15 cases have been reported with angiographic findings, confirming the duplicated origin of VA arising from ipsilateral subclavian artery.[4],[5] Clinical symptoms associated with anomalous origin of vertebral arteries include dizziness or vertigo. Anomalous variants of VA aberrantly enter at the C4-C5 level that predisposes their long prevertebral segments to atherosclerosis and dissections.[6] Our patient presented with a left middle cerebral artery stroke and neuroimaging showed an incidental finding of duplicated origin of right VA [Table 1] and [Figure 1]. Dual origin of VAs does carry clinical significance in diagnostic and therapeutic procedures. Incidental diagnosis of these anomalous variants could be of concern for both diagnostic and interventional neurologists due to their anatomical similarity with arterial dissections, predisposing to misinterpretation on routine, non-invasive vascular imaging. However with the advent of novel and multimodal imaging techniques, the diagnostic accuracy for these pathologies have remarkably increased.[7] Detailed diagnostic evaluation with conventional angiography is recommended in these patients to discern similar pathologies.
Table 1: Clinical characteristics of our patient with dual origin of vertebral artery

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Figure 1: (a) MRA neck without contrast demonstrating duplicate right vertebral artery originating from right subclavian artery; (b) Diagnostic cerebral angiogram showing duplicated origin of right vertebral artery with segments uniting at C4 level

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  References Top

1.
Satti SR, Cerniglia CA, Koenigsberg RA. Cervical vertebral artery variations: An anatomic study. AJNR2007;28:976-80.  Back to cited text no. 1
[PUBMED]    
2.
Kendi AT, Brace JR. Vertebral artery duplication and aneurysms: 64-slice multidetector CT findings. Br J Radiol 2009;82:e216-218.  Back to cited text no. 2
[PUBMED]    
3.
Watanabe K, Saga T, Iwanaga J, Tabira Y, Yamaki K. A rare case of dual origin of the left vertebral artery without convergence. Folia Morphol 2016;75:136-42.  Back to cited text no. 3
[PUBMED]    
4.
Thomas AJ, Germanwala AV, Vora N, Prevedello DM, Jovin T, Kassam A, et al. Dual origin extracranial vertebral artery: Case report and embryology. J Neuroimaging 2008;18:173-6.  Back to cited text no. 4
[PUBMED]    
5.
Baik J, Baek HJ, Shin HS, Choi KH. Duplication of the right vertebral artery: MRA findings and review of the literature. SpringerPlus2016;5:1123.  Back to cited text no. 5
[PUBMED]    
6.
Melki E, Nasser G, Vandendries C, Adams D, Ducreux D, Denier C. Congenital vertebral duplication: A predisposing risk factor for dissection. J Neurol Sci2012;314:161-2.  Back to cited text no. 6
[PUBMED]    
7.
Malhotra K, Liebeskind DS. Imaging in endovascular stroke trials. J Neuroimaging 2015;25:517-27.  Back to cited text no. 7
[PUBMED]    


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