Rutherford's 100: Vertebral Artery Dissection and Other Conditions скачать в хорошем качестве

Rutherford's 100: Vertebral Artery Dissection and Other Conditions

#VertebralArtery #VertebrobasilarIschemia #VBI #StrokePrevention #PosteriorCirculation #VascularDisease #VertebralArteryDissection #SubclavianSteal #VertebralArteryStenosis #Diagnosis #Treatment #VascularSurgery #EndovascularTherapy #Stenting #Rutherfords #Anatomy This video, drawing on Rutherford's Vascular Surgery text, focuses on the vertebral arteries, critical vessels supplying the posterior brain areas like the brainstem, cerebellum, and occipital lobes. Approximately 25% of ischemic strokes occur in this region. The vertebral artery consists of four segments: V1 (origin from subclavian), V2 (within bony tunnels), V3 (mobile segment near skull base), and V4 (intracranial). The mobile V3 segment is notably vulnerable to dissection due to neck movements. Problems leading to vertebrobasilar ischemia (VBI) include reduced blood flow (hemodynamic), often from significant stenosis (60%) in both or a dominant vertebral artery, or embolic events (traveling clots), more likely to cause permanent strokes. Low flow symptoms are often transient, like dizziness or drop attacks. Subclavian steal is another low flow cause. Atherosclerosis is common at the V1 origin. V2 issues often involve extrinsic bone compression or trauma. V3 is a prime site for dissection, sometimes from minor trauma. Diagnosis requires a thorough history, exam, and imaging: ultrasound (limited), CTA/MRA (detailed, non-invasive), and conventional angiography (gold standard for dynamic assessment and planning). Treatment depends on the cause and severity of symptomatic disease. Medical therapy is initial. Surgical reconstruction (e.g., V1 transposition, V3 bypass) or endovascular therapy (stenting) are options if medical therapy is insufficient or for specific lesions. Surgery offers durable, high patency rates (90% at 10 years for proximal) with relatively low stroke/death risks (1% proximal, ~3% distal). Endovascular stenting is less invasive but carries risks like embolization and significant restenosis (around 23%), though technology is improving. Patient selection is paramount.