Endovascular treatment of a patient with traumatic dissection lesions of both vertebral arteries obtained during chiropractic manipulation
The observation of endovascular treatment of a 34-year-old woman with bilateral dissection lesions of vertebral arteries in V4-segments with occlusion of the right vertebral artery and right posterior inferior cerebellar artery, severe stenosis of the left vertebral artery caused by chiropractic manipulation in the neck region is described. There are intensive staticolocomotor and dynamic coordinating insufficiency, severe neck pain, headache, severe dizziness, Wallenberg syndrome, moderate central tetraparesis. MRI of the brain on the DWI Isotropic identified the hyperintensive round-shaped foci in the right hemisphere of the cerebellum, in the right side of cerebellum worm, in the right side of the medulla oblongata and in the right side of the pons (DWI BSS 3). Selective cerebral angiography was performed an hour after the clinic manifestation. Simultaneously, balloon angioplasty of severe dissection stenosis was performed in the V4-segment of the left vertebral artery by the compliant balloon-catheter Scepter C. In 18 hours from the development of vertebral artery dissection, self-expending stent LVIS was implanted into the left vertebral artery in the zone of dissection lesion. On the control angiograms: the left vertebral artery patency is restored without stenosis all along. The stent is fully opened. A second contrast contour is determined outside the stent in the dissection zone. All the arteries of the vertebrobasilar basin above the vertebrobasilar junction are passable. The V4-segment of the right vertebral artery is contrasted through the vertebrobilar junction. There was a rapid regression of neurological symptoms in the postoperative period. Only mild hypoesthesia on the right side in the outer Sölder’s zone, light coordination disorders on the right were remained. Control selective cerebral angiography revealed recanalization of the right vertebral artery and the right posterior cerebellar artery. But distal basin of the right posterior cerebellar artery is very poorly. The left vertebral artery is passable all over, but in the place of the former dissection, two equivalent arterial «sleeves» were formed according to the fenestration type. One «sleeve» is formed by a stent, the other — outside. All arteries of the vertebrobasilar basin are contrasted. The mild hemihepesthesia on the right side of the face in the outer Sölder’s zone, light coordination disorders on the right are remained.
Implantation of the self-expanding stent LVIS allowed to restore the dominant vertebral artery and restrict ischemic brain damage in the brain stem and cerebellum in a patient with a both vertebral arteries dissection lesion caused by chiropractic neck manipulations.
Rubinstein SM, Peerdeman SM, van Tulder MW, Riphagen I, Haldeman S. A systematic review of the risk factors for cervical artery dissection. Stroke. 2005;36(7):1575-80.
Chowdhury MM, Sabbagh CN, Jackson D et al. Antithrombotic treatment for acute extracranial carotid artery dissections: A meta-analysis. Eur. J. Vasc. Endovasc. Surg. 2015;50:148-56. doi: 10.1016/j. ejvs.2015.04.034.
Dziewas R, Konrad C, Drager B et al. Cervical artery dissection – clinical features, risk factors, therapy and outcome in 126 patients. J. Neurol. 2003;250(10):1179-84. [Medline].
Mourand I, Machi P, Nogué E et al. Diffusion-weighted imaging score of the brain stem: a predictor of outcome in acute basilar artery occlusion treated with the solitaire FR device. Am. J. Neuroradiol. 2014;35 (6):1117-23. doi: https://doi.org/10.3174/ajnr.A3870
Caprio FZ, Bernstein RA, Alberts MJ et al. Efficacy and safety of novel oral anticoagulants in patients with cervical artery dissections. Cerebrovasc. Dis. 2014;38:247-53. doi: 10.1159/000366265.
Gross BA, Albuquerque FC. Antiplatelets vs anticoagulation for cervical arterial dissection. Word Neurosurg. 2015;84:18-25.
Haldeman S, Kohlbeck FJ, McGregor M. Stroke, cerebral artery dissection, and cervical spine manipulation therapy. J. Neurol. 2002;249(8):1098-104. [Medline].
Kim YK, Schulman S. Cervical artery dissection: pathology, epidemiology and management. Thromb Res. 2009;123(6):810-21. doi: 10.1016/j.thromres.2009. 01.013.
Shi S, Chen K, Ge X, Ni B. Lessons from the diagnosis and treatment of spontaneous vertebral arterial dissection. Case report. Interv. Neuroradiol. 2009;15(2):203-8.
Markus HS. Antiplatelets vs anticoagulation for dissection: CADISS nonrandomized arm and meta-analysis. Neurology. 2013;80:970-1.
Stevinson C, Honan W, Cooke B, Ernst E. Neurological complications of cervical spine manipulation. J. R. Soc. Med. 2001;94(3):107-10. [Medline].
Gensicke H, Ahlhelm F, Jung S et al. New ischaemic brain lesions in cervical artery dissection stratified to antiplatelets or anticoagulants. Eur. J. Neurol. 2015;22:859-65,e61.
Norris JW. Anticoagulants versus antiplatelet drugs for cervical artery dissection: Case for anticoagulants. J. Neural. Transm (Vienna) 2013;120:333-4.
Norris JW, Beletsky V, Nadareishvili ZG. Sudden neck movement and cervical artery dissection. The Canadian Stroke Consortium. CMAJ. 2000;163(1):38-40. [Medline].
Smith WS, Johnston SC, Skalabrin EJ et al. Spinal manipulative therapy is an independent risk factor for vertebral artery dissection. Neurology. 2003;60(9):1424-8. [Medline].
Goyal N, Male S, Doss VT et al. Spontaneous dissection of the bilateral internal carotid and vertebral arteries: A rationale for endovascular management. J. Neurol. Sci. 2015;350:112-4.
Saeed AB, Shuaib A, Al-Sulaiti G, Emery D. Vertebral artery dissection: warning symptoms, clinical features and prognosis in 26 patients. Can. J. Neurol. Sci. 2000;27(4):292-6.
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