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Torn pica artery9/9/2023 ![]() ![]() The absence of visualization was considered to be aplasia. Arteries with less than 50% of expected diameter (when compared with neighbouring portion or contralateral side) were considered hypoplastic. The magnetic resonance imaging (MRI) examination was performed using a 1.5-T unit (Signa EXCITE HD 1.5T, GE Healthcare Japan, Tokyo, Japan). The prevalence of vertebral artery with hypoplasia, occlusive lesion, direct arch origin and that terminating in the PICA (PICA termination) was evaluated by means of preoperative MRA. Open surgical repair was performed for 121 patients (aortic root and/or ascending aorta 23, aortic arch 63, descending aorta 22 and thoracoabdominal aorta 13), and TEVAR for 38 patients. The aetiology of aortic disease consisted of 115 degenerative aneurysms, 41 chronic aortic dissection and 3 infected aortic aneurysms. One hundred and twenty-two (77%) were male, and 37 (23%) were female. PATIENTS AND METHODSĪmong the 214 patients who underwent thoracic aortic surgery from January 2009 through December 2012, 159 patients who underwent preoperative MRA were retrospectively analysed. In this study, we evaluated the prevalence of variation or occlusive lesion of the vertebral artery by preoperative magnetic resonance angiography (MRA) and report its impact upon operative strategy and outcomes. Therefore, knowledge of vertebral artery variation may be indispensable in thoracic aortic surgery. ![]() In addition, vertebral artery hypoplasia has recently been considered to be a predisposing factor for posterior circulation cerebral ischaemic events. A good example of such a situation is a vertebral artery that terminates in the posterior inferior cerebellar artery (PICA). However, continuity of the Willis circle does not guarantee the blood flow to the cerebellum during left subclavian artery occlusion, when hypoplasia or occlusive lesion is present in the distal vertebral artery. Previous works have focused mainly upon the development of the circle of Willis in this regard. This is true both in the field of brain protection during open surgery and in the situation of left subclavian coverage during thoracic endovascular aortic repair (TEVAR). Vertebral artery, Posterior inferior cerebellar artery, Left subclavian artery occlusion, Magnetic resonance angiography, Brain infarction INTRODUCTIONĪlthough the importance of the contribution of the left subclavian artery to the brain posterior circulation has been well recognized, its management during thoracic aortic surgery has been controversial. ![]()
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