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Iatrogeni dissection of the right vertebral artery

This 53 year old female patient had iatrogenic dissection of the right vertebral artery occurring during diagnostic catheter based cerebral angiography. Follow-up of the dissection was carried out with MRA.

Examination 1
Fig.1 DSA images (A-P views) with opacification of the right subclavian artery immediately after the accidental dissection. The wedge shaped progressive stenosis of the right vertebral artery, as well as the intimal flap (arrow) at the proximal end of the false lumen are demonstrated.

Examination 2 (3 months follow-up, 0.5 T)
Fig.2 Coronal survey 2D PC MR angiogram of the cervical blood vessels (TR: 18 ms, TE: 9.1 ms, flip angle: 20 degrees, matrix: 256, Nex: 4, Venc: 35 cm/s, Tac: 36 sec). Flow is detected in the right vertebral artery (arrows).

Fig.3 Coronal collapsed (left) and targeted (right) MIP reconstructions of the cervical blood vessels from a 3D PC MRA acquisition (TR: 38 ms, TE: 13 ms, flip angle: 20, matrix: 256, Nex: 2, Venc: 30 cm/s, Tac: 15 min 05 sec). The right vertebral artery is thinner than the left (this might represent normal asymmetry) and exhibits irregular caliber along its cervical course, typical for dissections after recanalization.

Fig.4 Coronal averaged modulus (left) and directional phase differences (right) type source images from a 3D PC (Venc: 20 cm/s) MRA (above) and a survey 2D PC (Venc: 40 cm/s) MRA (below) acquisition. Caudo-cranial flow is encoded in white and cranio-caudal flow is encoded in black. Both vertebral arteries are represented with white pixels, signifying physiological caudo-cranial flow, confirming the recanalization and normalization of flow in the right vertebral artery. Because with the 3D PC acquisition a very low Venc value was selected (20 cm/s) for the presumably slow flow within the recanalized right vertebral artery, aliasing artifacts (arrow) occurred in the left vertebral, the right common carotid and the right internal jugular vein. After readjusting the Venc value for the 2D PC acquisition (Venc: 40 cm/s), the aliasing artifacts disappear.

 

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Fig. 1

Iatrogeni dissection of the right vertebral artery, Fig. 1
Iatrogeni dissection of the right vertebral artery, Fig. 2
Iatrogeni dissection of the right vertebral artery, Fig. 3
Iatrogeni dissection of the right vertebral artery, Fig. 4