J Korean Neurosurg Soc.  2018 Jan;61(1):28-34. 10.3340/jkns.2017.0202.007.

Duplicated Vertebral Artery : Literature Review and Clinical Significance

• Kim MS

• KMID: 2403520
• DOI: http://doi.org/10.3340/jkns.2017.0202.007

Abstract

OBJECTIVE
Duplication of the vertebral artery (VA) is a rare vascular variant. This paper describes the anatomy and embryological development of duplicated VAs and reviews the clinical significance.
METHODS
Computed tomography (CT) angiography was performed in 3386 patients (1880 females, 1506 males) between March 2014 and November 2015. We defined duplication of the VA as a condition in which the VA has two origins that fused at different levels of the neck.
RESULTS
Ten of the 3386 patients (0.295%) who received CT angiography had a dual origin of the VA; three on the left side, and seven on the right side. In all seven with right dual origin of the VA, both limbs of the VA origin originated from the right subclavian artery. In all three patients with left dual origin of the VA, both limbs of the VA originated from the left subclavian artery and aortic arch. In all 10 patients, the medial limb of the duplicated VA was located posteriorly and medially to the common carotid artery (CCA) and anteriorly and laterally to the vertebral transverse foramen. In two patients, the medial limb of the duplicated VA was located in close proximity to the CCA. In another two patients, the medial limb of the duplicated VA was located in close proximity to the CCA, carotid bifurcation, and proximal internal carotid artery.
CONCLUSION
Although duplication of the VA is asymptomatic in most patients, clinicians should consider this anomaly during diagnosis and treatment.

Keyword

Vertebral artery; Congenital abnormalities; Embryonic development; Computed tomography angiography

MeSH Terms

Angiography
Aorta, Thoracic
Carotid Artery, Common
Carotid Artery, Internal
Congenital Abnormalities
Diagnosis
Embryonic Development
Extremities
Female
Humans
Neck
Pregnancy
Subclavian Artery
Vertebral Artery*

Figure

• 

  Fig. 1 Reconstructed computed tomographic (CT) angiography shows a left duplicated vertebral artery (VA) originating from the left subclavian artery and aortic arch (A : yellow arrow, medial limb of the left duplicated VA; white arrow, lateral limb of the left duplicated VA). Axial neck CT at the sixth cervical vertebral body level after contrast enhancement shows that the medial limb of the left duplicated VA is located anteriorly to the vertebral transverse foramen. The medial limb of the duplicated VA is located between the longus coli muscle and anterior scalene muscle (B : black arrow, lateral limb of the left duplicated VA; white arrow, medial limb of left VA, red arrow, left internal jugular vein; yellow arrow, left common carotid artery; yellow arrowhead, longus coli muscle; blue arrowhead, anterior scalene muscle).

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  Fig. 2 Computed tomographic (CT) angiography of a 38-year-old woman with a right duplicated vertebral artery (VA) originating from the right subclavian artery. Reconstructed CT angiography shows a right duplicated VA originating from the right subclavian artery (A : blue arrow, right subclavian artery; yellow arrow, lateral limb of the right duplicated VA; white arrow, medial limb of the right duplicated VA). Axial neck CT at the fifth cervical vertebral body level after contrast enhancement shows that the medial limb of the duplicated right VA is located anteriorly to the vertebral transverse foramen and between the longus coli muscle and anterior scalene muscle (B : black arrow, medial limb of the right duplicated VA; yellow arrow, lateral limb of the right VA; blue arrow, right common carotid artery [CCA]; red arrow, right internal jugular vein; blue arrowhead, longus coli muscle; yellow arrowhead, anterior scalene muscle). Sagittal CT after contrast enhancement shows that the medial limb of the duplicated VA is located in close proximity to the CCA and proximal internal carotid artery (C : black arrowhead, medial limb of the duplicated VA; blue arrow, CCA; red arrow, lateral limb of the duplicated VA; black arrow, internal carotid artery).

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  Fig. 3 Computed tomographic (CT) angiography of a 58-year-old woman with a right dual-origin vertebral artery (VA). Reconstructed CT angiography shows a right duplicated VA originating from the right subclavian artery (A : red arrow, right subclavian artery; yellow arrow, lateral limb of the duplicated VA; blue arrow, medial limb of the duplicated VA; white arrow, junction of the two limbs of the duplicated VA). Axial neck CT at the fifth cervical vertebral body level after contrast enhancement shows that the medial limb of the duplicated VA is located posteriorly to the right common carotid artery (CCA) and anteriorly to the vertebral transverse foramen. The medial limb of the duplicated VA is located between the longus coli muscle and anterior scalene muscle (B : yellow arrow, medial limb of the right duplicated VA; black arrow, lateral limb of the right VA; blue arrow, right CCA; red arrow, right internal jugular vein; yellow arrowhead, anterior scalene muscle; blue arrowhead, longus coli muscle). Sagittal CT after contrast enhancement shows that the medial limb of the duplicated VA is located in close proximity to the CCA (C : blue arrow, medial limb of the duplicated VA; yellow arrowhead, CCA; yellow arrow, lateral limb of the duplicated VA; white arrow, junction of the two limbs of the duplicated VA).

Reference

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