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| Vertebral artery | |
|---|---|
| Name | Vertebral artery |
| Latin | arteria vertebralis |
| Caption | Course of the vertebral artery |
| Branchfrom | Subclavian artery |
| Branchto | Posterior inferior cerebellar artery; basilar artery |
| Supply | Spinal cord; medulla oblongata; cerebellum; posterior cerebral circulation |
Vertebral artery is a paired major artery of the neck that ascends through the transverse foramina of the cervical vertebrae to enter the cranial cavity and contribute to the basilar artery. It supplies posterior circulation structures including portions of the brainstem, cerebellum, and spinal cord, and is clinically significant in stroke, trauma, and surgical procedures. The vessel is commonly studied in relation to cervical spine anatomy, cerebrovascular disease, and endovascular interventions.
The artery typically arises from the ipsilateral Subclavian artery and courses superiorly between the anterior scalene and longus colli muscles before entering the transverse foramen of the sixth cervical vertebra, then ascends through the foramina of successive cervical vertebrae, curves posteriorly over the posterior arch of the atlas, pierces the dura mater at the foramen magnum, and joins its contralateral counterpart to form the Basilar artery. Along its course it gives off branches including the posterior inferior cerebellar artery (PICA), meningeal branches, cervical spinal branches, and muscular branches that anastomose with branches of the Ascending cervical artery and deep branches of the Occipital artery. Anatomical relations include proximity to the vertebral bodies, uncovertebral joints, and the atlantoaxial complex; important neighboring structures include the Common carotid artery, Internal jugular vein, vagus nerve (CN X), accessory nerve (CN XI), and sympathetic trunk.
Embryologically, the artery develops from longitudinal anastomoses of cervical intersegmental arteries derived from the dorsal aorta during the fourth to eighth weeks of gestation. The proatlantal intersegmental artery and connections with the Basilar artery and primitive dorsal aorta influence definitive anatomy; perturbations in regression or persistence of these embryonic channels can produce persistent fetal anastomoses such as a persistent proatlantal artery or persistent hypoglossal artery. Genetic and teratogenic factors described in embryology texts and studies of vascular development influence the patterning alongside signaling pathways studied in laboratories at institutions such as Harvard Medical School, Stanford University, and Max Planck Society.
Common anatomical variations include differences in level of entry into the transverse foramina (eg, entering at C7, C5), asymmetry between the right and left arteries, hypoplasia or aplasia of one vertebral artery, fenestration, duplications, and anomalous origin directly from the Aortic arch or from the Common carotid artery. Rare persistent embryonic connections such as persistent proatlantal intersegmental artery, persistent hypoglossal artery, or persistent trigeminal artery can alter posterior circulation and have been reported in case series from centers like Mayo Clinic, Cleveland Clinic, and major neurosurgery departments. Osteological variations of the cervical vertebrae, traumatic fractures (eg, of the atlas in high-energy injuries like those described in reports from Johns Hopkins Hospital), and degenerative spondylotic changes can also affect the arterial course.
The arterial supply contributes critically to the posterior circulation of the brain, joining as the basilar artery to supply the cerebellum, brainstem structures including the medulla and pons, and posterior cerebral arteries that perfuse occipital lobes and thalamic regions. Collateral pathways involve anastomoses with the anterior circulation via the posterior communicating arteries of the Circle of Willis and extracranial-intracranial connections with branches of the External carotid artery such as the occipital and ascending cervical arteries. Physiologic studies from institutions like University of Oxford, Columbia University, and Karolinska Institutet have characterized flow dynamics, autoregulation, and the role in vertebrobasilar insufficiency syndromes.
Pathologies include atherosclerotic stenosis, dissection from blunt or iatrogenic trauma, thromboembolic occlusion causing posterior circulation stroke, aneurysms (notably PICA-region aneurysms), and entrapment related to cervical spondylosis or osteophytes. Vertebral artery dissection is associated with neck manipulation, sports injuries, and connective tissue disorders studied in clinics at Mayo Clinic and Massachusetts General Hospital. Clinical presentations can include vertigo, diplopia, ataxia, dysphagia, Wallenberg syndrome (lateral medullary infarct), and ischemic events documented in epidemiologic registries such as those maintained by World Health Organization and regional stroke networks. Management intersects neurology, neurosurgery, otolaryngology, and vascular surgery specialists from centers including Cleveland Clinic and Mount Sinai Health System.
Evaluation employs duplex ultrasonography, computed tomography angiography (CTA), magnetic resonance angiography (MRA), and digital subtraction angiography (DSA) for detailed lumenography. High-resolution vessel wall MRI and cone-beam CT are used to assess dissection, intramural hematoma, and aneurysm morphology; perfusion imaging evaluates ischemic penumbra in posterior circulation strokes, used in acute care protocols at centers such as Stanford Health Care and University College London Hospitals. Noninvasive studies screen for stenosis and flow dynamics, while catheter angiography remains the gold standard for endovascular planning.
Therapeutic options include anticoagulation or antiplatelet therapy for dissection, surgical decompression for entrapment, microsurgical clipping or bypass for complex aneurysms, and endovascular techniques such as stenting, coil embolization, flow diversion, and parent artery occlusion. Procedures are performed by multidisciplinary teams in tertiary centers like Cleveland Clinic, Barrow Neurological Institute, Johns Hopkins Hospital, and international neurointerventional units; device selection, navigation via the subclavian and vertebral segments, and protection of branches such as PICA are critical technical considerations. Postoperative follow-up employs imaging surveillance with CTA, MRA, or DSA and neurological assessment following guidelines from organizations such as the American Heart Association and European Stroke Organisation.
Category:Arteries of the head and neck