Vascular stenosis in the cervical spine: causes and symptoms of pathology. What is vertebral artery syndrome

Stenosis vertebral artery – dangerous disease, which consists in narrowing the lumen of a blood vessel. The vertebral artery is responsible for transporting blood to the human brain, and therefore vertebral artery stenosis is fraught with the development of ischemic stroke.

What it is

About 70-75% of the blood entering the human head passes through the carotid arteries. If the blood flow in one of the veins is disrupted, then, accordingly, the overall blood supply to the head deteriorates. Even if there is no complete blockage of the artery, but only a circulatory disorder, the patient will definitely feel a deterioration in health: loss of vision and hearing, dizziness, general weakness.

Spinal artery stenosis is a narrowing or complete blockage of a vessel that disrupts the normal blood supply to the brain and its nutrition. As a result, hypoxia develops, that is, oxygen starvation head organs. As a rule, symptoms of stenosis begin to develop if the lumen of the vessel narrows by half.

Stenosis of the right vertebral artery, stenosis of the left vertebral artery, or stenosis of both may develop. blood vessels. If the disease develops, it can lead to disability and even death. In order to prevent such sad consequences, it is necessary to try to start appropriate treatment as quickly as possible.

Symptoms

Regardless of whether vertebral artery stenosis is observed on the left or right, the symptoms are the same:

severe attacks of headache that cannot be relieved with conventional painkillers. In this case, migraine often has a paroxysmal character, accompanied by a drop in visual acuity and severe dizziness;
lower back pain that gets worse during exercise. In this case, the discomfort does not disappear even in a sitting or lying position. You can ease the sensation a little by leaning forward;
feeling of cold, numbness in the extremities, crawling on the skin, weakness in the muscles. As a rule, after a short warm-up, the discomfort disappears;
development of hypertension. To ensure normal blood flow, the body begins to increase blood pressure. As a result, the patient may develop hypertension.

If a patient experiences these symptoms, this means that the disease is progressing, and therefore appropriate measures should be taken immediately.

Reasons for appearance

Doctors call following reasons development of vertebral artery stenosis:

congenital factor, that is, a hereditary predisposition to vascular diseases. In some patients, the disease practically does not progress and does not interfere with a person’s full life;
acquired reasons: diabetes, metabolic disorders, atherosclerosis. As a rule, such reasons appear with age, most often in people over 40 years of age;
injuries. Often the cause of a decrease in the lumen of the artery is injury to the vessel. It may not even be a full-fledged wound, but a banal bruise, when a hematoma occurs at the site of the impact. In case of poor regenerative ability, the lumen may narrow down to the point of complete blockage of the vessel.

Diagnostic issues

To diagnose the problem, a comprehensive examination should be performed. First, the doctor interviews the patient, finding out what exactly he is complaining about. Particular attention should be paid to the issue of dizziness, headaches and the like.

The first diagnostic method is Doppler ultrasound. This method The examination allows you to study the condition of the blood vessels in the brain, identifying disturbances in their functioning.

X-rays can be used to check blood flow to determine the presence of atherosclerotic plaques. When deciding on the advisability of surgical intervention, it is necessary to perform contrast panangiography.

In case of exacerbation, it makes sense to conduct magnetic resonance imaging, which will determine the quality and speed of blood flow, and also allow us to study the condition of each layer of the walls of the vertebral artery. Computed tomography is performed with introduction into circulatory system contrast agent and allows you to accurately determine the location and degree of narrowing of the blood vessel.

Since insufficient examination has repeatedly turned out to be the reason for the diagnosis misdiagnosis, then it is necessary to carry out the maximum diagnostic procedures. If the doctor doubts the diagnosis ( similar symptoms has a whole range various diseases), then it makes sense to undergo a re-examination at another medical institution.

The treatment method depends on the degree of neglect and speed of development of the disease.

First of all, the doctor should recommend conservative treatment. The first step should be to completely eliminate the factors that contribute to the growth of atherosclerotic plaques. For this purpose, statins are prescribed - drugs aimed at combating cholesterol in the patient’s body. To restore blood flow speed, smoking should be completely eliminated.

To avoid blood clots, it is necessary to use antiplatelet therapy. The most inexpensive and yet effective way is to take acetylsalicylic acid(Aspirin). The drugs should be used throughout life.

In advanced cases, surgical intervention is required. The following methods are considered the most effective:

endarterectomy - removal of part of the artery wall affected by atherosclerotic plaques. A normal vessel has smooth walls, but if atherosclerosis develops, growths form on them, preventing normal blood flow. In some cases, the lumen is completely blocked by atherosclerotic plaques. The endarterectomy technique involves the surgeon making an incision in the artery at the site of the lesion. Through this incision, special instruments are used to clean the artery from plaques. The operation allows you to return the lumen to normal size and restore normal blood flow;
endovascular artery repair with stent implantation. In this case, the doctor inserts a special stent into the vein through a catheter, which expands the vessel and restores blood flow. Endovascular arteryplasty is used when stenosis develops in hard-to-reach areas, after radiation therapy and in some other cases.

Traditional methods

Traditional medicine on this moment cannot offer a truly effective technique. All kinds of decoctions and tinctures can strengthen the walls of blood vessels and improve blood flow, but the problem will not be completely solved.

Can stop the progression of the disease proper nutrition. To do this, you need to exclude fatty and fried foods and introduce sea fish rich in healthy fats into your diet. Eat as many vegetables and fruits as possible, try to limit tea, coffee, and packaged juices.

Allows you to get rid of many weight loss problems. Be sure to do morning exercises, and do not neglect visiting the gym.

In the list of health disorders associated with cervical osteochondrosis, a special place is occupied by the so-calledvertebrobasilarsyndrome. Special because along withotherscerebrovascular disorders this pathology not only reduces the patient's quality of life, but, if not treated promptly, can pose a serious threat to the patient's health and well-being.

What is vertebrobasilar syndrome?

WITHvertebral artery syndrome with cervical osteochondrosis is a complex of disorders that arise due to hemodynamic disturbances in the vertebral artery basin. This condition is one of the complications of cervical osteochondrosis, capable, due to the specific anatomical features of the vertebral artery, of leading to disorderfunctioningalmost all organs and systems.

Crystal attention to this pathology is due to that, in addition to subjective discomfort(pain, dizziness, vision problems), vertebrogenic the syndrome can negatively affect the vital functions of a number of structures of the central nervous system, which causes health threatening and life state.

Causes

The reasons for the development of this pathology lie in the anatomical features of the cervical department of the spine and in particular the most arteries. This paired vessel is a branch approaching the sixth cervical vertebra, vertebral arteryenters the canal formed by the processes of the cervical vertebrae (from the first point about the sixth) . From this canal the vertebral artery enters scull .

Lying in the bone canal, the vertebral artery susceptible and deformations with the slightest instability of the cervical vertebrae , as well as with a decrease in the height of the intervertebral discs.

Development mechanismsvertebrogenic syndrome:

Due to Deformation of the artery reduces the volume of blood flow through it, which leads to a disruption of the blood supply to the basal structures of the brain.
Another development mechanism pathological symptoms associated with cervical osteochondrosis is irritation or even infringement of the sympathetic nerve bundle that runs along with the vertebral artery. Injury to nerve fibers leads to the rapid development of neurological symptoms.

This is how a pathological symptom complex is formed, better known asvertebral artery syndrome due to cervical osteochondrosis.

Risk factors

There are a number of conditions that make it more likely thatvertebral artery syndrome occurs with cervical osteochondrosis (causes of the diseaselie in the pathology of the spine), This:

WITH am osteochondrosis.
AND excess body weight, characteristic of obesity.
Systemic diseases accompanied by metabolic disorders (diabetes mellitus, atherosclerosis).
H excessive emotional stress and physical stress.
WITH systematic toxic effects (alcohol, nicotine).
Genetically determinedpredisposition to vascular disorders.

Clinical manifestations

Symptoms given vascular pathology very recognizable:

Expressed p Restupous headaches, characterized by a pulsating character and spreading from the back of the neck to the back of the head, and from there towards the temples and frontal region.More often headache at vertebrogenic syndrome has unilateral localization.

B painful sensations, localizeddirectly tosurface of the scalp.
N vestibular disorders th apparatus: feeling instability as while walking, so and at rest, swaying, episodes of dizziness, hearing loss, audibility extraneous sounds in the form of ringing or noise in the ears."Swimming away the floor from under your feet" when turning your head sharply.
Subjective decrease in visual acuity due to sparks, flies, fog or veil flickering before the eyes, feeling of sand in the eyes.
N muscle tension and soreness neck (especially upon palpation).
Episodes of numbness in any area of the face.
Violations in the area cardiovascular with pheres in the form of episodes of tachycardia, pain in the chest, a feeling of lack of air during inspiration.
Psychological manifestations in the form of attacks of aggression, panic attacks, depressive states or a tendency toward apathy.

In addition to high blood pressure, which often accompanies , main symptoms this vascular disorderV severe cases may be accompanied by the following symptoms:

T nausea that occurs at the height of the attack and ends with vomiting.
P cracking and crunching when making movements in cervical spine - tilting and turning the head.
U intensification of pathological phenomena with sides vision: double vision, narrowing of the field of vision, blurred vision.
P progression of hearing loss and increased pathological noise.
R swallowing disorder.
Deterioration of sensitivity of the skin of the lips, mucous membrane of the tongue and pharynx; numbness and paresthesia in these areas.
P loss of consciousness. Often this condition is preceded by a backward position of the head (as, for example, when looking up). Approximation loss of consciousness can be recognized by increased nausea and dizziness, speech impairment, and sudden loss of vision in one of the eyes.

These signs, combined with pain and other signs exacerbation of cervical pathology practically unmistakably point to.

Diagnostics

Variety of subjective signs vertebrogenicsyndrome and different perceptions of complaints by different patients are significantly makes diagnosis difficult vertebrobasilar syndrome . In this regard, a list of mandatory examinations was developed to identify objective signs characteristic of this pathology.

D complex scanning or Doppler ultrasound of arteries to identifyextravasaldeformations of the vertebral artery.
X-ray of Shane s vertebrae using functional tests and image fixation during flexion and extension of the cervical spine.

M RT (m magnetic resonance imaging) revealing presence, degree andlocalization of blood vessel deformations.

Cervical osteochondrosis syndrome is diagnosed when the patient has three main clinical criteria:

N the presence of a set and combination of symptoms characteristic of a given pathology.
IN identified using methodsmagnetic resonance imaging and x-ray And typical changes.
Characteristic abnormalities detected during scanning, as well as during Dopplerography of the vertebral arteries using stress tests, when bending and straightening the head.

This list of diagnostic criteria was established to avoid overdiagnosisvertebrogenic syndrome.

The importance of differential diagnosis

Sharp attacks of headaches combined with dizziness and nausea against the background of rising blood pressure, as well as the likelihood of loss of consciousness, may indicate both stroke in vertebro-basilar basin, transient ischemic attack or infectious-toxic lesion nervous tissue with neuroinfections, and to identify vertebral artery syndrome in cervical osteochondrosis. Symptoms arise suddenly, which makes it difficult to collect anamnesis. Both conditions are classified as emergencies and are indications forhospitalization and detailed examination.

Differential diagnosis is necessary for correct selection of treatment for each of the listed diseases.

Drug therapy

In case of vascular pathology, to which includes, treatmentmust be comprehensiveand address not only the etiology, but also focus on the correction of disorders resulting from circulatory disorders.

The first step in drug treatment is selection non-steroidal anti-inflammatory drugs to eliminate neurogenic inflammation. Etc priority is given drugs from the NSAID group electoral type,blocking only the enzymecyclooxygenasesecond type; This approach combines effectiveness in combating the disease withsafety for the patient. Typical representatives of this group of drugs are products based on nimesulide, meloxicam or celecoxib.
A number of disorders that cause symptoms in vertebrogenic syndrome, develops under the influence of pathologicalhypertonicity muscles of the neck and This is one of the signs that we have before us- vertebral artery syndrome with cervical osteochondrosis. Reviewspatients testify that the inclusion of muscle relaxants in the treatment regimen contributes to a more rapid normalization of well-being and general condition. From a group of suchdrugs good effect give "M" Idocalm", "S irdalud", "B aclofen" . By eliminating muscle spasm, muscle relaxants reduce the intensity of pain, thereby reducing the need for non-steroidal anti-inflammatory drugs.Important point! While using these medications, you should avoid activities that require increased attention and quick reactions.In addition, such work is incompatible with vestibular disorders, which manifest.
Treatment of conditions caused by hemodynamic failure vertebrobasilar area, unthinkable without the use of funds, normalizing microcirculation , bioactive substances and other drugs whose action is aimed at combating tissue hypoxia.

Physical methods

As an independent treatment method, physiotherapy insufficiently effective; requires an integrated approach to treatment.However, as an auxiliary physiotherapy gives quite good results.

Massage for vertebrogenic syndrome is often contraindicated even during remission, since it can cause displacement of the vertebrae and pinching of the neurovascular bundle.

The preferred technique for this pathology is reflexology, which can relieve muscle spasms without causing harm to the patient or aggravating his condition.

The orthopedic regimen is of no small importance (immobilization of the cervical spine using I wear Shants collar). This one is especially important moment in cases where deterioration patient's conditionassociated with changes in position or movements of the head.

Outside of an aggravation, it is necessary to take a set of measures to strengthenmuscular frame of the neck. Due to the specific nature of the pathology, the decision on the advisability of exposure through massage or exercise therapy must be taken by a specialist. Exercises alsomust be fulfilledunder the supervision of a specialist.

Traditional methods

Among the recipes containing folk experience in the treatment of certain disorders, there are also means that help cope with with some manifestationsvertebrogenic syndrome.

Using garlic to reduce blood viscosity. To obtain the medicinal composition, three large heads of garlic must be chopped and kept in the dark. those three days. Then the mass must be filtered and added to it equal quantities honey and lemon juice. P and t Before going to bed, take a tablespoon.
Takingcomposition preparedfrom 40 grams of corn silk, 20 grams of lemon balm, lemon juice andglass of boiling water. After an hour of infusion, takehalf a glass three times a day 30 minutes before meals.

It should be remembered: in such a serious situation as causes diseases and multiple disordersare not eliminated herbal infusions or other folk remedies. A complete scheme therapy can only be prescribed by the attending physician after a detailed examination of the patient. Folk remedies are used as auxiliary; their use is permissible subject to the following conditions:

No allergic reactions to ingredients.
ABOUT no contraindications and approval of the attending physician.

Indications for surgical treatment

The decision on surgical intervention is made in case of development due tovertebrogenic syndrome the following pathological conditions:

AND ischemic attacks, strokes.
And intellectual-mnestic, cognitive disorders.
WITH rapid progression of disorders vision, hearing and balance.

In addition, cases wherecombined with severe arterial hypertension, anatomical abnormalities of the vertebral artery or atherosclerosis, as well as the ineffectiveness of therapeutic measures.

Complications

The most serious complication of vertebrobasilar syndrome is a stroke. Its consequences can be:

AND loss of hearing.
P complete loss of vision.
WITH Cardiovascular failure.
Insufficiency of the respiratory system.

Stenosis of the vertebral artery is its narrowing, as a result of which blood circulation in the brain is disrupted, nutritional deficiency and oxygen starvation occur. nerve cells(neurons) and ischemic stroke. Vertebral arteries (VA) are one of the main vessels passing on both sides of the spine (left and right artery) and supply the brain with blood (up to 25% of the total volume of blood entering the head).

The essence of pathology

Chronic insufficiency occurs when there is a shortage of 35-40% of blood and is characterized by the following symptoms:

dizziness, migraines that are not affected by analgesics;
deterioration of vision - phenomena of floaters, dark spots or visual images before the eyes;
deterioration of memory and intellectual abilities;
impaired coordination of movements due to damage to the cerebellum;
lumbar pain, aggravated by walking and physical exercise subsiding when bending forward;
a feeling of numbness in the limbs, tingling and “pins and needles” in the legs, weakness in the muscles;
arterial hypertension;
pain in the neck occipital region.

If the vertebral artery is narrowed by half, the patient’s condition worsens, sudden attacks of loss of consciousness and circulatory failures become more frequent, during which some brain cells die.

Reasons for the development of stenosis

According to the factors that provoked the development of stenosis, 3 main groups are classified:

Hereditary pathologies associated with blood vessels. In the absence of exacerbation, the disease does not manifest itself and the person remains active throughout his life.
Stenosis acquired as a result of diseases affecting blood circulation (atherosclerosis, diabetes and metabolic disorders).
Narrowing of arterial walls due to injury (bruise, fracture, hematoma).

Reasons for the development of stenosis:

diseases that cause degeneration and dystrophy of the vertebral columns of the cervical region (osteochondrosis, spondylosis, ankylosing spondylitis), leading to confusion of the vertebrae and disruption of brain microcirculation;
atherosclerosis of blood vessels due to the concentration of cholesterol plaques in the vascular cavity;
tumors of the vertebral processes;
bone growths (osteophytes) in the joints of the intervertebral space;
hypertonicity and spasms of the cervical and scalene muscles.

Depending on the affected areas, the following types of VA stenosis are distinguished:

Estuary stenosis is a form of damage to the vertebral arteries on the right or left, accompanied by mental disorders, which manifest themselves in outbreaks of panic attacks, fear of death, compression pain in the frontal region, irritability and fear of light. The main treatment is surgical.
Subcompensated stenosis is provoked by injuries and resulting displacements in the cervical spine. Surgery is necessary to correct post-traumatic complications. If the lesion is caused oncological tumor, then such a disease ends in death.
Vertebrogenic stenosis - characterized by the manifestation of pain in the lumbar and sacral regions of the spine without any processes of inflammation and moderate changes in the frontal lobe of the brain cortex. The vertebral vessel is examined using MRI. Treatment is surgical through stenting through a puncture of the femoral artery and installation of an endoprosthesis.
Compensated stenosis is characterized by a slow course of the disease, when the lumen of the vessel walls gradually narrows and makes it possible to treat the disease with medication, without surgery.
Intracranial stenosis causes arterial thrombosis, progresses rapidly and provokes a stroke.
Narrowing of the left vertebral artery is a consequence of abnormal changes in the spine (cervical osteochondrosis, intervertebral hernia, cancerous tumors). The prognosis when the sources of disease development are completely eliminated is favorable, the blood supply to the brain tissue is restored.
Right vertebral artery stenosis—symptoms and treatment are similar to stenosis on the left side of the spine.
Dynamic narrowing of the VA - is expressed in complete or partial disruption of the patency of the arteries and is considered the most dangerous looking stenosis Treatment with drugs is only symptomatic; emergency surgical care is required.
Functional stenosis - manifests itself only in a certain position of the neck, progresses due to existing osteochondrosis, spondylosis and other lesions of the spine.
Multifocal stenoses are lesions of several or many vessels. Only drug therapy or angioplasty is used, which involves replacing damaged artery tissue.
Hemodynamic means that the obstruction affected more than half of the vessel, which disrupts the functioning of the brain.
Decompensated stenosis - the disease becomes chronic, the process becomes irreversible. The prognosis is relatively favorable with complete replacement of the narrowed section of the arterial vessel or the creation of an alternative blood flow channel.
Stenosis of the spinal canal due to its narrowing. This type of stenosis is observed in the lumbar region and causes compression of the nerve roots of the lumbar plexus and neuralgia of the sciatic nerve. Can also be observed in the cervical region spinal cord, squeezing the latter, which can lead to complete paralysis.

Diagnosis of insufficiency of cerebral blood supply

To study the blood circulation of the brain, the following instrumental methods are used:

Dopplerogram of the vessels of the cervical spine to identify processes of narrowing of the arteries;
angiography - the introduction of contrast agents into the vessels and their x-ray to exclude atherosclerotic and anatomical disorders of the vascular system;
magnetic resonance angiography - scanning of contrast arteries;
CT using a contrast solution injected into the artery to determine the degree of stenosis;
Contrast panangiography is an X-ray using contrast agents to identify the presence and location of a blood clot for surgery.

Treatment of the disease

Narrowing of the vertebral artery is a disease that requires timely treatment, otherwise complications can lead to ischemic stroke. Treatment of stenosis is prescribed based on the causes of the pathological processes and the type of stenosis.

Drug therapy provides an impact on the signs of the disease, suppressing their manifestation: drugs that lower blood pressure are used (Indap, Lozap, Dibazol, etc.); orthopedic collars that limit the mobility of the cervical vertebrae; anticoagulants; means for normalizing blood circulation (Cinnarizine, Mildronate, Encephabol, Vasobral, Instenon, etc.); NSAIDs. However drug treatment effective only in 30-40% of cases, and there is a danger of regression of the disease.

In such situations, the use of radical methods is required.

Surgical intervention involves various types of operations depending on the course and localization of the process of narrowing of the vascular walls. Among them:

Endarterectomy - resection of damaged sections of the artery and insertion of an implant (stent).
Reconstructive operations - arteriolysis, resection and redressing of damaged sections of the VA.
Stabilization of the movement of the moving part of the spine.
Removal of osteophytes - bone growths in intervertebral joints.
Stenting is the insertion of a metal frame lined with plastic into the artery canal, which protects the vessel walls from narrowing.
Fixation of the cervical spine when removing some articular elements by installing special titanium systems.

Prognosis of VA stenosis

The prognosis of the disease in the vast majority of cases is quite unfavorable, the outcome is influenced by location degenerative changes in PA. Critical stenosis of the right VA usually results in a stroke with possible death. Patients who have suffered this illness are assigned a disability.

In contact with

The vertebral artery is a paired vessel that arises from the subclavian artery and, together with the carotid arteries, provides blood supply to the brain.

With vascular anomalies, the preconditions are created for a decrease in cerebral blood flow. This is exactly what happens with hypoplasia of the right vertebral artery, and what is it? Hypoplasia is the underdevelopment of an organ, which results in a decrease in its functionality. In the case of the vertebral artery, hypoplasia occurs when the diameter of the vessel decreases to less than 2 mm. This type of anomaly is congenital and is often a consequence of pregnancy pathology.

Symptoms often appear only in adulthood due to deterioration in the elasticity of blood vessels and the addition of atherosclerosis. In such a situation, there may be a decrease in blood flow to certain parts of the brain. To a certain extent, the pathology of the blood supply can be compensated, but the body’s defense mechanisms may be depleted or fail to work in emergency situations.

There are usually no differences from lesions of the left vertebral artery. The only difference is that right-sided lesions of the vessel occur several times more often than left-sided ones - according to some observations, in a ratio of approximately 3 to 1.

CT scan image

It is difficult to give a definite answer about the danger of the condition. Brain neurons are especially sensitive to malnutrition due to impaired blood supply. Therefore, hypoplasia of the arteries leading to the brain can lead to more serious consequences for the body compared to the underdevelopment of other vessels. The degree of danger depends on the severity of hypoplasia and associated health problems (vascular diseases, pathology of the cervical spine, heart disease).

Complete cure disease is impossible, even after surgery only temporary compensation of local blood flow can be achieved.

Neurologists usually treat hypoplasia of the vertebral arteries. IN medical care Only those patients in whom hypoplasia is manifested by certain symptoms of deterioration of cerebral circulation are needed. With a significant narrowing of the lumen of the vessel with severe symptoms circulatory disorders requires consultation with a vascular surgeon to decide whether surgery is necessary.

Causes of hypoplasia of the right vertebral artery

Underdevelopment of vertebral vessels is often detected accidentally during examination in adulthood. However, this pathology is congenital. Underdevelopment of blood vessels can be caused by various health problems of a pregnant woman, injuries during pregnancy, and hereditary predisposition.

List of possible causes of vertebral artery hypoplasia:

Infections suffered during pregnancy: rubella, influenza, toxoplasmosis.
Bruises or injuries to the mother.
Drinking alcohol, taking medications during pregnancy, smoking, drug addiction.
Genetic characteristics that increase the risk of developing defects in the circulatory system.

The pathology can be asymptomatic for a long time. If the circulatory disturbance and symptoms are insignificant, the condition may be mistakenly attributed to other pathologies: osteochondrosis, vegetative-vascular dystonia.

Hypoplasia is considered one of the most common anomalies of the vertebral arteries. Data on the prevalence of hypoplasia among the population differ in different sources and range from 2.5 to 26.5% of cases. But it is known that hypoplasia of the vertebral artery on the right is noticeably more common than on the left or on both sides at the same time. This is probably due to anatomical features formation of vascular formations. The vessel on the right departs from the subclavian artery at an acute angle, on the left almost at a right angle, the diameter of the right artery is often smaller than the left, and its length is greater.

The asymptomatic course of the anomaly of the right vertebral artery indicates sufficient compensation of blood flow due to the existing connections (anastomoses) between the vessels and due to the developed network of collaterals - branches of other vessels supplying blood to the same areas as the vertebral artery. Ensuring uniform blood flow to all parts of the brain is achieved largely due to the presence of closed circulatory systems, when the arteries of different vascular basins merge with each other. The listed protective mechanisms often compensate for insufficient blood flow through the right vertebral artery for a long time. Therefore, clinical manifestations often appear gradually as age-related changes develop.

Symptoms of pathology

Symptoms of this disease are very diverse and can vary significantly between patients.

Here are several groups of symptoms:

Characteristics of disease manifestations:

Pain in pathology can vary significantly in intensity and other characteristics.
Patients often feel throbbing or shooting pain spreading from the neck and back of the head to the temporo-frontal areas.
The pain intensifies when turning the head, at night and after waking up.
Often hypoplasia is manifested by dizziness, a feeling of disorientation, and a distortion of the perception of the body’s position in space. Such episodes are often associated with head tilts, sudden movements. They can lead to staggering or even falling.
Sudden attacks of dizziness are sometimes accompanied by loss of consciousness and fainting.

In addition to pain, the following disorders may occur in pathology:

blurred vision, pain in the eyes, double vision, feeling of sand or flashing spots;
hearing impairment, tinnitus, sensorineural hearing loss, vestibular disorders;
problems with the cardiovascular system;
mood swings, depression;
fatigue, weakness;
sleep disturbance;
weather sensitivity.

Arterial hypertension and angina attacks are not always a direct consequence of an abnormality of the vertebral vessels. Typically, the combination of cardiac pathology with hypoplasia leads to a worsening of the disease. In this case, reduced blood flow in the vertebrobasilar region provokes episodes of myocardial ischemia and an increase in blood pressure.

Hypoplasia of the right vertebral artery increases the risk of developing cerebral stroke due to impaired blood flow in the vertebrobasilar system and due to damage vascular wall in case of development of atherosclerosis.

Treatment methods

In the case of vascular hypoplasia, complete cure of the disease is impossible. Even after reconstructive surgery, only temporary compensation of local blood flow can be achieved.

Conservative therapy

Conservative treatment includes medications, physiotherapeutic methods, physical therapy, and acupuncture. To improve blood supply to the brain, several groups of drugs are used:

Vasodilators (Cavinton, Actovegin, Ceraxon).
Neuroprotectors and nootropics (piracetam, glycine, picamilon, mexidol) that improve metabolic processes in brain tissue.

Betahistine, effective in the presence of dizziness.

Antihypertensive drugs are necessary in case of increased blood pressure: calcium antagonists (amlodipine), beta-blockers (bisoprolol), ACE inhibitors (angiotensin-converting enzyme) (lisinopril).

Prevention of blood clots is carried out with the help of antiplatelet agents (aspirin, pentoxifylline, clopidogrel).

Physiotherapeutic methods can be used:

diadynamic currents;
magnetic therapy;
electrophoresis with drugs that have a vasodilator and analgesic effect.

Surgery

Surgery can be performed open method or using the endovascular method (through small holes, without large incisions).

To restore blood flow, use:

Stenting, in which a stent - a frame - is inserted into the site of narrowing of the vessel to widen the narrowed area. Such stents can be impregnated with drugs.
Angioplasty, in which a balloon is inserted into the narrowed area and inflated with air to widen the vessel. Angioplasty and stenting can complement each other.
In severe situations, a more complex reconstructive operation is performed: removal of the deformed area and prosthetics using the patient’s own vein.

Forecast

The prognosis for the pathology of hypoplasia of the right vertebral artery depends on the degree of underdevelopment, compensatory mechanisms of the body, and concomitant pathologies. In the absence of symptoms of deterioration in cerebral blood flow or minimal manifestations of pathology, the prognosis can be considered conditionally favorable.

Hypoplasia is considered a predisposing factor for the development of stroke. According to statistics, 70% transient disturbances cerebral circulation and 30% of strokes are associated with impaired blood flow in the vertebrobasilar system. Therefore, detecting an anomaly requires taking active preventive measures, especially in the presence of other risk factors.

The presence of pronounced manifestations of vertebrobasilar insufficiency significantly worsens the prognosis. If conservative therapy is insufficiently effective, only surgery. Good results are obtained using the endovascular method, which can be performed even in patients at high “surgical risk.”

Narrowing of the vertebral artery: right, left

At early diagnosis vertebral compression, proper treatment prevents irreversible changes in brain tissue. Through this vessel blood flows to the brain tissue. About 20% of the structures are fed by blood supply from the vertebral arteries on the right and left, passing through the openings of the transverse processes of the vertebrae of the neck.

1. Dyspeptic phenomena(vomiting, nausea);

2. Pain syndrome of the cervical-occipital part;

3. Peripheral tenderness (helmet removal symptom);

4. Strengthening the clinic when sleeping on a pillow;

The task of an x-ray in the presence of a drop attack (sudden fall) is to establish the likelihood of a violation of the blood supply in the vertebrobasilar system, to identify possible displacement of the vertebrae, instability, and scoliosis. For these purposes, functional photographs are taken with maximum flexion and extension of the neck. X-rays help assess the degree of cervical flexion and exclude or confirm vertebral instability.

With any of these disorders, decreased vision, eye fatigue, and pathology are observed. visual analyzer. With late therapy, it is impossible to prevent the irreversible development of visual impairment using either conservative or surgical methods. X-rays of the cervical spine do not show shadows of the vessel. To study the state of blood supply, contrast angiography, magnetic resonance imaging, and Doppler sonography are required.

The procedures are performed under local anesthesia. The stent is installed through a puncture femoral area. The introduction of an endoprosthesis is necessary to maintain the physiological lumen of the vessel. Until a few years ago, stenting was performed under X-ray control. A scopic cover was used to visualize the insertion of the balloon stent. The movement of the balloon from the femoral to the vertebral artery is clearly visible on the X-ray television screen. The procedure led to radiation exposure of the patient, so at the present stage the intervention is monitored under the guise of ultrasound.

1. Headache syndrome is characterized by dull, burning pain with localization in the parieto-occipital region. The symptom intensifies with severe physical activity. The probable location of pain is the superciliary, temporal, parietal areas;

2. Symptoms from the outside gastrointestinal tract. Nausea and vomiting occur in many patients with vertebrobasilar insufficiency. It is impossible to fight them with medications. The mechanism of dyspeptic disorders is compression of the vertebral artery with impaired blood supply to the intestines;

3. Disorders of the central nervous system - memory loss, changes in visual acuity, eye pain;

4. Vestibular disorders – disorientation, tinnitus;

1. Elimination of neurogenic spasm;

2. Improving microcirculation of the vertebrobasilar area;

1. Magnetic resonance imaging allows you to determine anomalies in the structure of the bone bed in which the vessels run;

2. X-ray of the cervical spine - to identify vertebral instability, displacement, neck hernia, and other anatomical structures that interfere with blood flow in the vertebrobasilar region;

3. Dopplerography helps evaluate blood flow deviations from normal values. The more the circulation is reduced, the more likely severe complications in the brain;

4. Duplex scanning – is prescribed to identify lesions localized on the inner wall of the vessel;

To determine the level of blood supply disturbance in the area of the base of the brain, a ultrasound scanning with Dopplerography. The procedure is used not only to identify blood supply disorders, but also for the purpose of dynamic monitoring of the nature of microcirculation during treatment with vasodilator drugs.

MRI angiography is considered a fairly promising method that shows the condition of the transcranial and brachiocephalic arteries. The study allows you to carefully study the nature of the cerebral blood supply, identify blood clots, and stenosis of the vertebral artery. Magnetic tomography reveals atherosclerotic plaques, determine the features of angiography.

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Vertebral artery stenosis: symptoms

Possible consequences of vertebral artery stenosis and treatment of narrowing

Congenital or acquired vertebral artery stenosis is a pathological disorder leading to ischemic disease and cerebral stroke.

The difficulty of therapy lies in the fact that in the early stages of the disease there are practically no symptoms. Drug treatment brings relief only in 30-40% of cases.

The positive effect of prescribing drugs is temporary. Complete cure is possible only after surgery.

What is spinal stenosis

Literally, the term stenosis refers to a blockage, blockage, or narrowing of a blood vessel. As a result of the disturbances, blood flow becomes difficult and the intensity of the supply of nutrients and oxygen to the brain decreases.

Signs of stenosis of the left vertebral artery canal begin to appear after the internal cavity of the vessel narrows by more than 50%.

Since the vertebral artery provides about 35-40% of the total blood supply to the brain, chronic failure, evidenced by characteristic symptoms:

Headaches - migraine crises are accompanied by dizziness and loss of vision clarity. The pain syndrome is not relieved with conventional analgesics.
Lower back pain is one of the first symptoms of spinal vascular stenosis. The intensity worsens during walking and physical activity. The pain does not go away when stopping or at rest. A decrease in pain is observed when the back is tilted forward.
Numbness of the limbs. With the development of pathology and continued narrowing of the distal section, a syndrome is observed restless legs(pins and needles sensation), muscle weakness, tingling. Usually, the discomfort goes away when changing body position, especially when bending forward.
An increase in blood pressure occurs due to the body’s independent attempts to ensure normal blood supply to the brain. With prolonged hypertension, symptoms characteristic of arterial hypertension are observed: decreased visual acuity, impaired motor coordination, etc.

Appearance clinical manifestations indicates that pathological changes have become life-threatening for the patient.

There are three main causes of vertebral artery stenosis:

Congenital factor - genetic predisposition leads to congenital disorders in the structure of blood vessels.

If the disease does not progress, people with such stenosis live a full life, with virtually no restrictions.

The acquired factor is one of the main reasons why treatment of vertebral artery stenosis is required.

Blockage of blood vessels can be caused by atherosclerosis, diabetes and metabolic disorders.

Traumatic factor. Narrowing of the artery occurs due to bruise, fracture, or hematoma at the site of injury.

Surgical treatment is required to eliminate the causes of artery blockage.

How dangerous is the disease?

The prognosis of the disease is extremely unfavorable and mainly depends on the location pathological changes. Critical stenosis of the right vertebral artery leads to a stroke and death is possible. The progressive form of the disease is a criterion for disability.

Regardless of whether surgical treatment was performed, the patient in the later stages of stenosis is placed in the disability group. Disability may be prescribed taking into account the consequences of stenosis (severe stroke, etc.

)Methods of treating the disease and the consequences of stenosis largely depend on its location.

Estuary stenosis - characterized by serious emotional disturbances: attacks panic fear death, frontal pressing pain and associated irritability, photophobia. Depending on the causes of pathological changes, surgical intervention and drug therapy in the preoperative period are recommended.
Subcompensated stenosis - mainly occurs as a result of a traumatic factor. It is impossible to cure with drug therapy; surgical correction is necessary. Another common cause of development is cancer. In this case, the pathology often ends in death.
Vertebrogenic stenosis - characteristic features is pain in the lower back and area sacral region. Stenosis is not accompanied by inflammatory processes. MRI shows signs of moderate atrophy of the frontal lobe of the cerebral cortex.
Compensated stenosis - the development of pathology is slow, there are no signs of an acute form of the disease. As a result, there is no need for urgent surgical intervention.
Intracranial stenosis is accompanied by arterial thrombosis. Under unfavorable circumstances, the disease progresses rapidly and a stroke occurs.
Stenosis of extravasal compression of the left vertebral artery - develops as a result of abnormal diseases of the spine. The cause of development may be cervical osteochondrosis, hernia, cancer and other pathologies. After eliminating the causes of the disease, blood supply is usually restored.
Stenosis of extravasal compression of the right vertebral artery - for this diagnosis, the etiology and causes of development are identical to the narrowing observed in the left side of the spine.
Dynamic stenosis - accompanied by complete or partial occlusion of the vessel. It is extremely dangerous for the patient's life. Drug therapy treats only symptoms and is mainly used to prepare the patient for surgery.
Functional stenosis - symptoms occur only in a certain position of the neck. The development of the disease occurs only against the background of osteochondrosis, spondylosis and other disorders of the structure of the spine.
Multifocal stenoses are multiple vascular lesions. Surgery is ineffective. Drug therapy is prescribed, and if it is ineffective, angioplasty with complete replacement of damaged parts of the arteries
Hemodynamically significant stenosis is a condition in which there is a narrowing of blood vessels of more than 50%. The result is a condition that affects normal blood flow and, accordingly, brain activity.
Decompensated stenosis is one of the most severe conditions. The narrowing of the lumen of blood vessels takes chronic form and becomes irreversible. The only possible solution is to completely replace the damaged section of the artery or create a backup channel.

Before prescribing treatment methods, it is necessary to carry out differential diagnosis to determine the exact cause of the development of disorders, the degree of development and form of the disease. Classification of the degree of stenosis plays an important role in determining the advisability of prescribing surgery.

What methods are used to treat the disease?

There are three main areas of treatment for spinal vascular stenosis.

Drug therapy - vascular drugs are prescribed to promote the development of elasticity and strength, medicines to control blood pressure, thin the blood and help reduce blood clots.

Simultaneously in complex therapy physical therapy is used manual therapy and hirudotherapy.

Surgical intervention - surgical correction is performed to eliminate complications after injuries and disorders in the structure of the spine.

Stenosis is also treated with stenting. A metal frame is inserted into the artery to prevent rupture and further narrowing of the vessel. The duration of operation of stents is about 15 years. To reduce the likelihood of rejection, the steel frame is coated with plastic.

As a prevention of stenosis, a fairly effective method of therapy.

To prescribe the optimal type of therapy, the attending physician refers to several diagnostic procedures.

One of the most informative ways to obtain a complete picture of pathological changes is duplex scanning arteries. In addition, an MRI of the stenosis may be required.

Ultimately, the decision of what to treat depends on the patient himself. If the patient has constant dizziness, chronic lack of air, vasoconstriction over 70%, are absolute indications to perform a surgical operation.

What diet is optimal for treatment

The therapeutic diet is aimed at overcoming the causes of narrowing of the arteries. There is no specially designed diet.

Instead, you should consume as much as possible more fish(any variety), fruits and vegetables. You should be careful when drinking alcohol, coffee and tea.

It has been observed that losing just a few kilograms of weight reduces the risk of rapid development of stenosis due to atherosclerosis. Therapeutic gymnastics is one of the the best ways normalize the patient's weight.

Although many developments have recently appeared aimed at overcoming stenosis, so far the only method of combating a disease that has high efficiency, surgery remains.

Spinal artery stenosis: left, right, what it is, symptoms

Stenosis of the vertebral artery is its narrowing, as a result of which blood circulation in the brain is disrupted, nutritional deficiency occurs, oxygen starvation of nerve cells (neurons) and ischemic stroke. The vertebral arteries (VA) are one of the main vessels that run along both sides of the spine (left and right arteries) and supply the brain with blood (up to 25% of the total volume of blood entering the head).

The essence of pathology

Chronic insufficiency occurs when there is a shortage of 35-40% of blood and is characterized by the following symptoms:

dizziness, migraines that are not affected by analgesics;
blurred vision - the appearance of floaters, dark spots or visual images before the eyes;
deterioration of memory and intellectual abilities;
impaired coordination of movements due to damage to the cerebellum;
lumbar pain, aggravated by walking and exercise, subsided by bending forward;
a feeling of numbness in the limbs, tingling and “pins and needles” in the legs, weakness in the muscles;
arterial hypertension;
pain in the cervical-occipital region.

Reasons for the development of stenosis

According to the factors that provoked the development of stenosis, 3 main groups are classified:

Hereditary pathologies associated with blood vessels. In the absence of exacerbation, the disease does not manifest itself and the person remains active throughout his life.
Stenosis acquired as a result of diseases affecting blood circulation (atherosclerosis, diabetes and metabolic disorders).
Narrowing of arterial walls due to injury (bruise, fracture, hematoma).

Reasons for the development of stenosis:

diseases that cause degeneration and dystrophy of the vertebral columns of the cervical region (osteochondrosis, spondylosis, ankylosing spondylitis), leading to confusion of the vertebrae and disruption of brain microcirculation;
atherosclerosis of blood vessels due to the concentration of cholesterol plaques in the vascular cavity;
tumors of the vertebral processes;
bone growths (osteophytes) in the joints of the intervertebral space;
hypertonicity and spasms of the cervical and scalene muscles.

Depending on the affected areas, the following types of VA stenosis are distinguished:

Estuary stenosis is a form of damage to the vertebral arteries on the right or left, accompanied by mental disorders that manifest themselves in outbreaks of panic attacks, fear of death, compression pain in the frontal part, irritability and fear of light. The main treatment is surgical.
Subcompensated stenosis is provoked by injuries and resulting displacements in the cervical spine. Surgery is necessary to correct post-traumatic complications. If the lesion is caused by an oncological tumor, then such a disease ends in death.
Vertebrogenic stenosis is characterized by the manifestation of pain in the lumbar and sacral regions of the spine without any inflammatory processes and moderate changes in the frontal lobe of the cerebral cortex. The vertebral vessel is examined using MRI. Treatment is surgical through stenting through a puncture of the femoral artery and installation of an endoprosthesis.
Compensated stenosis is characterized by a slow course of the disease, when the lumen of the vessel walls narrows gradually and makes it possible to treat the disease with medication, without surgery.
Intracranial stenosis - causes arterial thrombosis, rapidly progresses and provokes a stroke.
Narrowing of the left vertebral artery is a consequence of abnormal changes in the spine (cervical osteochondrosis, intervertebral hernia, cancerous tumors). The prognosis when the sources of disease development are completely eliminated is favorable, the blood supply to the brain tissue is restored.
Right vertebral artery stenosis - symptoms and treatment are similar to stenosis on the left side of the spine.
Dynamic narrowing of the VA is expressed in complete or partial disruption of the patency of the arteries and is considered the most dangerous type of stenosis. Treatment with drugs is only symptomatic; emergency surgical care is required.
Functional stenosis - manifests itself only in a certain position of the neck, progresses due to existing osteochondrosis, spondylosis and other lesions of the spine.
Multifocal stenoses are lesions of several or many vessels. Only drug therapy or angioplasty is used, which involves replacing damaged artery tissue.
Hemodynamic vasoconstriction means that the obstruction has affected more than half of the vessel, which disrupts the functioning of the brain.
Decompensated stenosis - the disease becomes chronic, the process becomes irreversible. The prognosis is relatively favorable with complete replacement of the narrowed section of the arterial vessel or the creation of an alternative blood flow channel.
Stenosis of the spinal canal due to its narrowing. This type of stenosis is observed in the lumbar region and causes compression of the nerve roots of the lumbar plexus and neuralgia of the sciatic nerve. It can also be observed in the cervical spinal cord, squeezing the latter, which can lead to complete paralysis.

Diagnosis of insufficiency of cerebral blood supply

To study the blood circulation of the brain, the following instrumental methods are used:

Dopplerogram of the vessels of the cervical spine to identify processes of narrowing of the arteries;
angiography - the introduction of contrast agents into the vessels and their x-ray to exclude atherosclerotic and anatomical disorders of the vascular system;
magnetic resonance angiography - scanning of contrast arteries;
CT using a contrast solution injected into the artery to determine the degree of stenosis;
Contrast panangiography is an X-ray using contrast agents to identify the presence and location of a blood clot for surgery.

Treatment of the disease

Drug therapy involves influencing the signs of the disease, suppressing their manifestation: drugs that lower blood pressure are used (Indap, Lozap, Dibazol, etc.

); orthopedic collars that limit the mobility of the cervical vertebrae; anticoagulants; means for normalizing blood circulation (Cinnarizine, Mildronate, Encephabol, Vasobral, Instenon, etc.); NSAIDs.

However, drug treatment is effective only in 30-40% of cases, and there is a danger of regression of the disease.

Surgical intervention involves various types of operations depending on the course and localization of the process of narrowing of the vascular walls. Among them:

Endarterectomy - resection of damaged sections of the artery and insertion of an implant (stent).
Reconstructive operations - arteriolysis, resection and redressing of damaged sections of the VA.
Stabilization of the movement of the moving part of the spine.
Removal of osteophytes - bone growths in intervertebral joints.
Stenting is the insertion of a metal frame covered with plastic into the artery canal, which protects the vessel walls from narrowing.
Fixation of the cervical spine when removing some articular elements by installing special titanium systems.

Prognosis of VA stenosis

The prognosis of the disease in the vast majority of cases is quite unfavorable; the outcome is influenced by the location of degenerative changes in the VA.

Critical stenosis of the right VA usually results in a stroke with possible death.

Patients who have suffered this illness are assigned a disability.

Symptoms and treatment of vertebral artery stenosis

Vertebral artery stenosis is a disease that can be either congenital or acquired.

The most common and serious complications in this case are coronary heart disease and stroke.

And the difficulty of treating such a pathology is that in the initial stages there are almost no symptoms.

The term itself means nothing more than a blockage, obstruction or narrowing of blood vessels.

As a result, there is a violation of blood flow, as a result of which the brain receives an insufficient volume of blood, and therefore oxygen and nutrients.

The first signs begin to appear when the narrowing of the artery reaches 50%, and even with a lack of 40% of the total blood supply, chronic failure occurs, which is manifested by the following symptoms:

Headaches accompanied by dizziness, loss of visual acuity and clarity. Moreover, it is impossible to relieve the pain syndrome with analgesics or other drugs.
Lower back pain. This is one of the main symptoms of narrowing of the spinal vessels. The intensity becomes maximum when walking, during physical activity, and the pain does not disappear even at rest. A pose in which the back is tilted forward helps to reduce it.
Numbness of the extremities, which manifests itself in restless legs syndrome, muscle weakness, tingling. Most often, such manifestations disappear after changing body position.
High blood pressure is an attempt by the body to independently compensate for the lack of blood flow to the brain.

All these manifestations mean that pathological changes in the vessels have reached a life-threatening stage for the patient.

Causes

Spinal artery stenosis does not occur without a cause. There are currently three known reasons for its development.

In the first case it is congenital factor, that is, a genetic predisposition that leads to any congenital abnormalities in the structure of the vessel.

If the disease does not progress, then people with such pathologies can live for many years without limiting themselves in anything.

The second reason is an acquired factor. This is the very reason that requires mandatory treatment. Atherosclerosis, diabetes mellitus, and metabolic disorders can provoke blockage.

And finally, the third factor is traumatic. Narrowing of the artery can occur due to a fracture, bruise, or hematoma. In this case, surgical treatment is mandatory.

How dangerous

In the presence of symptoms, the prognosis of vertebral artery stenosis is extremely unfavorable. A progressive form is always a reason for disability. But the treatment will completely depend on where exactly the pathology is localized.

The estuarine form is always emotional disturbances, which can be expressed in panic attacks and photophobia. The main treatment is surgical; drug therapy is required before surgery.

The subcompensated form occurs as a complication of traumatic injury. Drug treatment is not possible, only surgery is necessary. Another fairly common reason is oncology. In this case, most often the patient dies literally within a year.

Vertebrogenic stenosis is characterized by pain in the lower back and sacrum. However, it is not possible to detect any inflammatory processes.

The compensated form proceeds slowly, there are no signs of acute onset, and there is no need for urgent surgical treatment.

Intracranial stenosis occurs with arterial thrombosis and usually leads to death.

Left extravasal compression stenosis is a consequence of spinal diseases. The cause may be osteochondrosis, hernia, or oncology. After eliminating the causes, blood supply is most often restored to normal volume.

Stenosis of extravasal compression on the right has the same causes as the previous option.

The dynamic type is accompanied by complete or partial occlusion of blood vessels. This is the most life-threatening condition. Medicines can only help overcome the symptoms themselves, but the pathology can only be cured through surgery.

The functional symptom begins to manifest itself only in one position or another of the neck. The disease is based on spondylosis, osteochondrosis and other disorders.

Multifocal stenoses have numerous causes. The only way out– angioplasty with replacement of a section of the damaged artery.

Hemodynamically significant stenosis is observed when the vessel narrows by more than 50%.

The decompensated form is one of the most severe, when the narrowing of blood vessels is completely irreversible. The only way out is to completely replace the affected area or create a bypass channel for blood flow.

Treatment of vertebral artery stenosis begins after diagnosis and determination of the type of disease. Surgery is most often used; drug treatment is used extremely rarely.

Narrowing of the vertebral artery: right, left | Second opinion

Stenosis (narrowing) of the vertebral artery (left or right) leads to severe brain symptoms: severe pain in the left and right half of the head, loss of consciousness, convulsions. With right stenosis, the pain syndrome is localized on the right, with left stenosis - on the opposite side.

With early diagnosis of vertebral compression and proper treatment, irreversible changes in brain tissue are prevented.

Through this vessel blood flows to the brain tissue.

About 20% of the structures are fed by blood supply from the vertebral arteries on the right and left, passing through the openings of the transverse processes of the vertebrae of the neck.

MRI of the cervical spine in a patient with vertebrobasilar insufficiency

X-ray with narrowing of the lumen of the vertebral artery: right or left

Traditional radiography does not show narrowing of the lumen of the vertebral arteries (right or left) pathological manifestations. Neurologists send patients with certain clinical symptoms:

1. Dyspeptic symptoms (vomiting, nausea); 2. Pain syndrome of the cervical-occipital part; 3. Peripheral tenderness (helmet removal symptom); 4. Strengthening the clinic when sleeping on a pillow;

5. Shooting, throbbing pain when externally applied to the head (touch, wind).

In patients with vertebral artery stenosis, neurologists often see vestibular syndrome, in which staggering, instability, and severe attacks of dizziness are observed.

Even with an uncomplicated course, a short-term loss of consciousness is possible with a sharp turn of the head, vibration, or pressure on the neck. A person with such clinical symptoms should not drive a car.

Noise, nausea, hearing loss affect everyday life as a manifestation of a number of secondary pathologies from the inner ear and brain.

Traditional radiography of the cervical spine visualizes narrowing of the intervertebral discs during a degenerative-dystrophic process, prolapse, or hernia.

For these purposes, functional photographs are taken with maximum flexion and extension of the neck.

X-rays help assess the degree of cervical flexion and exclude or confirm vertebral instability.

MR angiography of the vertebral arteries with stenosis. When prescribing radiography, a radiologist identifies the proliferation of marginal osteophytes in the area of the semilunar joints. The changes are clearly visualized in the direct image. Osteophytes are localized along the upper edge of the contours of the anterior part of the vertebral bodies.

Lateral radiographs of the cervical spine examine the condition of the cervical vertebrae, intervertebral spaces, and hyperlordosis (excessive convexity of the natural curvature).

With any of these disorders, decreased vision, eye fatigue, and pathology of the visual analyzer are observed.

With late therapy, it is impossible to prevent the irreversible development of visual impairment using either conservative or surgical methods. X-rays of the cervical spine do not show shadows of the vessel.

To study the state of blood supply, contrast angiography, magnetic resonance imaging, and Doppler sonography are required.

Methods for radiological diagnosis of stenosis of the right or left vertebral artery will be discussed below.

Why does narrowing of the vertebral artery develop?

Impaired blood supply to the brain depends on the degree of compression of the vertebral artery. The narrowing is caused by atherosclerosis, nerve spasm, external compression of the vertebrae, tumor, thromboembolism.

The cause of impaired blood supply to the vertebrobasilar area may be tortuosity of one or both vertebral arteries. To treat the pathology, stenting and balloon angioplasty are used.

The procedures are performed under local anesthesia. The stent is installed through a puncture in the femoral area. The introduction of an endoprosthesis is necessary to maintain the physiological lumen of the vessel.

Until a few years ago, stenting was performed under X-ray control. A scopic cover was used to visualize the insertion of the balloon stent.

The movement of the balloon from the femoral to the vertebral artery is clearly visible on the X-ray television screen.

The procedure led to radiation exposure of the patient, so at the present stage the intervention is monitored under the guise of ultrasound.

Narrowing of the left vertebral artery: symptoms

Narrowing of the left vertebral artery can be suspected if the following symptoms are present:

1. Headache syndrome is characterized by dull, burning pain localized in the parieto-occipital region. The symptom intensifies with severe physical activity.

The probable location of pain is the superciliary, temporal, parietal areas; 2. Symptoms from the gastrointestinal tract. Nausea and vomiting occur in many patients with vertebrobasilar insufficiency.

It is impossible to fight them with medications. The mechanism of dyspeptic disorders is compression of the vertebral artery with impaired blood supply to the intestines; 3.

Disturbances of the central nervous system - memory loss, changes in visual acuity, eye pain; 4. Vestibular disorders – disorientation, tinnitus;

5. Changes in the frequency of contractions of the cardiovascular system, instability of pressure, attacks of angina.

In addition to surgical and conservative treatment, patients with vertebrobasilar insufficiency need to undergo an additional complex medical procedures– physiotherapy, massage, kinesiotherapy (treatment with physical movements).

Narrowing of both vertebral arteries is dangerous pathology, in which serious complications develop.

X-ray of the cervical spine in a lateral projection with a decrease in the height of the vertebral bodies at the lower level

Difficulties are caused by timely diagnosis of nosology. To identify the disease, not only x-rays are used, but also other radiation diagnostic methods.

Principles of treatment of vertebral artery syndrome

When both vertebral arteries are narrowed, treatment is aimed at eliminating the main pathogenetic links of the process:

1. Elimination of neurogenic spasm; 2. Improving microcirculation of the vertebrobasilar area;

3. Vertebrogenic effect on the tone of the vascular wall.

Complex treatment necessarily includes agents that reduce blood viscosity and dilate blood vessels - dipyridamole, pentoxifylline, vinpocetine.

X-rays with narrowing of the right or left vertebral artery are not used to diagnose the disease, but to identify possible reason compression of the vertebral vessel in the neck.

Methods for detecting compression of vertebral vessels (right and left)

Methods for diagnosing stenosis of vertebral vessels on both sides:

1. Magnetic resonance imaging allows you to determine anomalies in the structure of the bone bed in which the vessels run; 2.

X-ray of the cervical spine - to identify vertebral instability, displacement, neck hernia, and other anatomical structures that interfere with blood flow in the vertebrobasilar region; 3. Doppler sonography helps evaluate deviations of blood flow from normal values.

The more the circulation is reduced, the greater the likelihood of severe complications in the brain; 4. Duplex scanning – is prescribed to identify lesions localized on the inner wall of the vessel;

5. Angiography cervical vessels– examination after contrast injection into the vessel. CT or MRI may be used for imaging, as the methods allow for the creation of a three-dimensional simulation of the condition of the neck.

To determine the level of blood supply disturbance in the area of the base of the brain, an ultrasound scan with Doppler sonography is performed.

The procedure is used not only to identify blood supply disorders, but also for the purpose of dynamic monitoring of the nature of microcirculation during treatment with vasodilator drugs.

Neuroimaging through magnetic resonance imaging can be used to identify changes in the brain that lead to similar symptoms.

MRI angiography is considered a fairly promising method that shows the condition of the transcranial and brachiocephalic arteries.

The study allows you to carefully study the nature of the cerebral blood supply, identify blood clots, and stenosis of the vertebral artery.

Magnetic tomography reveals atherosclerotic plaques, determine the features of angiography.

X-ray of the cervical spine is used in conjunction with MRI for additional diagnostics. To obtain maximum information, it is recommended to perform functional tests at maximum extension and flexion.

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Narrowing of the vertebral arteries

As a result of narrowing of the vertebral arteries, insufficiency may occur arterial blood supply brain.

The atherosclerotic mechanism of cerebral circulatory disorders, according to De Bachi, is observed in approximately 40% of cases of all cerebral circulatory disorders.

Occlusions of arterial vessels can be partial or complete; The length of the blockage can be short or long, along the entire length of the artery.

Symptoms of narrowing of the vertebral artery

Occlusion of the vertebral artery is manifested by signs of insufficiency of the arterial vessels of the base of the brain: visual disturbances (cortical origin) and symptoms of cerebellar damage (equilibrium imbalance, diplopia, bilateral blindness or hemianopsia), as well as bilateral disturbances of sensitivity and movement, expressed differently. These disturbances may be transient or permanent.

The diagnosis of sclerotic narrowing of the vertebral arteries can be suspected during routine clinical trial the patient based on his medical history (transient neurological symptoms - paresis and paralysis, “flickering symptoms”), systolic murmur on the arterial vessels, a symptom of loss of consciousness with unilateral compression of the carotid artery.

With electroencephalography, pathological changes are found only with pronounced neurological symptoms, which reduces the value of this research method.

In some cases, electrical activity increases when the carotid artery of the other side is pressed or the head is raised sharply.

Topical diagnosis using electroencephalography is impossible.

The most accurate data on the localization and distribution of the lesion can be obtained from arteriography of the vertebral arteries.

It should be performed as early as possible, especially after an attack of cerebral arterial insufficiency, and if the symptoms of cerebral ischemia do not go away, then this study is carried out as an emergency intervention.

Arteriography of the vertebral artery is done by percutaneous puncture of the subclavian artery in the supraclavicular region. Inject 20 ml of 50% triyotrast.

It is necessary to examine the arterial vessel on the other side, since bilateral lesions occur in at least 25% of cases. X-ray done at the end of the administration of the contrast solution.

The study is then carried out on the opposite side.

Partial narrowing of the vertebral artery, visible on the arteriogram in the form of “filling defects”, “corrosion” of the contours of the artery wall, is an indication for surgery. If there is a complete blockage, the vessel is not filled with contrast solution and is completely invisible on the arteriogram.

Treatment of narrowing of the vertebral artery

The success of surgical treatment depends primarily on how early the operation is performed after the onset of the disease.

In some cases, the operation is successful in late period. The purpose of the operation is to restore blood supply to the brain.

Two types of surgery are used: endarterectomy or bypass with a plastic prosthesis.

Intimendarterectomy - removal of the altered intima along with the sclerotic plaque and the thrombus layered on it.

Endarterectomy of the vertebral artery, due to its small caliber, is performed from the lumen of the subclavian artery.

For this purpose, the latter is cut longitudinally above the origin of the vertebral artery.

In the case of simultaneous occlusion of the artery of the same name on the opposite side, special measures are required to protect the brain from ischemia during the operation.

For this purpose, a temporary external or internal (through the lumen of the artery) shunt with a thin polyethylene tube is applied. In addition, the decrease in blood flow is compensated by increasing blood pressure by administering norepinephrine.

Blood clotting in the temporary bypass is prevented by administering heparin.

In most cases, however, no special brain ischemia treatment is required for the period of surgical intervention (5-30 minutes), since the collateral blood supply is quite sufficient.

The operation brings either complete relief from the symptoms of insufficient blood supply to the brain, or a significant improvement in the condition. The results of treatment, followed over 5 years, remained stable.

The best effect is observed after surgery performed at the stage of sclerotic narrowing of the vessel, and not its occlusion. If the vessel is completely blocked, the operation is successful if it is performed soon after the onset of the disease.

Improved diagnosis and earlier referral for prompt assistance will further improve the results of surgical treatment of sclerotic lesions of the main arterial vessels supplying the brain.

Healthy:

symptoms, treatment and icd 10

The method of therapy and combating its consequences directly depend on the form of the disease and its location. Vertebral artery stenosis can be:

Causes of the disease

There are three main causes of vertebral artery stenosis:

Genetic predisposition. It can lead to congenital disorders of the vascular structure itself. If the disease does not progress, then they live with it fully ordinary life, without obvious restrictions.
Acquired factor. The following pathologies provoke blockage of blood vessels: atherosclerosis, metabolic disorders and diabetes. For this reason, mandatory treatment of the vertebral artery is necessary.
Traumatic factor. Narrowing of the vertebral artery artery can occur due to contusion, fracture, or hematoma formation at the site of injury. In this case, surgical treatment must be prescribed to eliminate the causes of artery blockage.

The causes of the disease are related to intrauterine development child:

Symptoms

The syndrome is expressed in a unique way, so patients note the following symptoms:

It can be burning or pulsating, spreading to the temple, crown or superciliary area.

Feature: the pain is localized either in the right or left side of the head. The pain plagues the patient constantly, but is especially intensified while walking or during sleep, if the position of the head or body predisposes it to this.

Much less often the pain is paroxysmal in nature. Patients often say that the pain has stopped, but they could not find a logical explanation for this. The reason for this is the position of the head. But there aren't any general rules about what position the head should be in order for the pain to disappear;

visual disturbances (decreased sharpness, feeling of sand in the eyes, blurry vision) or pain in the eyeballs;
auditory or vestibular disorders, for example, dizziness, loss of stability, noise in one ear, hearing loss;
cardiac manifestations if the person has cardiovascular disease, e.g. hypertension heart, ischemic.

If a patient suffers from coronary heart disease, angina attacks may occur in the form of acute pain in the heart area.

The development of the syndrome, in which the vertebral artery suffers, occurs in two stages - dystonic and organic. Symptoms and treatment for each stage vary and it is important to determine the extent of arterial damage by studying information about the signs of the disease.

In the first case, a person begins to feel symptoms such as:

constant pain in the temporal and occipital areas of the head, which intensifies with movements or being in one position for a long time;
transient dizziness of varying intensity;
violations visual perception, expressed in the appearance of “flies” and “snowflakes”. There is also a unilateral decrease in peripheral visual acuity.

Signs of the organic course of the disease have the following symptoms:

Diagnostics

Diagnosis of vertebral artery syndrome involves several different tests.

First of all, diagnosis is based on the data that can be obtained from the clinical picture of the disease. It's about about the patient’s complaints, as well as about the information that was obtained by the doctor during the neurological examination.

Quite often, diagnosis reveals tension in the neck muscles, difficulty turning the head, and pain when pressing on the processes of the first and second cervical vertebrae.

In addition, diagnosis means mandatory:

Circulatory disorders in the vertebral artery are diagnosed by Doppler ultrasound (USD). The method for studying the arteries of the vertebrobasilar and carotid basins is called ultrasound scanning of the branches of the aortic arch. In this case, the carotid arteries are fully examined, and the vertebral arteries are partially examined.

Most often, the examination begins with a blood test, which shows possible problems with the arteries.

Also, a standard procedure is to measure blood pressure; this indicator can not only identify arterial hypertension, but also determine the load on blood vessels, and therefore clarify risk factors for various diseases.

After this, additional diagnostics may be prescribed.

The disease can be identified during the first examination by a neurologist. The doctor listens to the patient’s complaints about his general condition, takes into account possible disorders in the cervical spine, and writes a referral for ultrasound diagnostics.

If during the examination a narrowing of the lumen in the diameter of the vertebral artery was revealed to 2 mm when the norm is 3.6 - 3.8 mm, this is considered a diagnostic symptom proving the presence of the disease. If necessary, angiography is performed - x-ray diagnostics of blood vessels using a contrast agent, clearly demonstrating their current condition.

If a disease is suspected, the doctor must write a referral for a vascular ultrasound. This diagnostic allows you to determine the diameter of the artery.

A narrowing of the internal diameter is considered an anomaly; the norm varies in the range of 3.6 - 3.8 mm.

According to indications, tomography and angiography of the arteries are performed using a contrast agent.

These studies help to obtain full picture vascular abnormalities.

Often, hypoplasia is aggravated by disorders of the vertebrae located in the cervical region. This can also be detected during diagnostics.

The following methods allow you to set a competent one:

Treatment

Stenosis can be treated using three effective techniques:

Modern medicine offers many methods of treating arteries, both conservative and surgical. However, these diseases still remain among the most severe and difficult to treat.

This is largely due to the fact that the processes taking place in the left and right arteries of the extremities, great vessels, vessels of the brain and heart are influenced by many factors, for example, the composition of the blood, the work of the heart muscle, the condition of the veins, and age-related changes in tissues.

Therefore, treatment should be carried out comprehensively, taking into account all possible causes.

Depending on the stage of development and the presence of factors influencing the clinical picture, treatment of vertebral artery syndrome may be conservative or require surgical intervention. In the dystonic course of the syndrome good result gives medicinal method, in which the patient is given medications that stimulate blood flow and improve chemical composition blood.

At the same time, physical therapy can be prescribed, which will help increase the clearance between the walls of the arteries and eliminate the early stages of osteochondrosis.

IN in some cases in the treatment of cervical osteochondrosis deserves good reviews special gymnastics, which not only reduces discomfort, but also improves cerebral blood supply.

Treatment is carried out using two methods:

Conservative. It involves the introduction of drugs that improve blood properties, blood supply to the brain and metabolic processes in it. Such methods do not completely eliminate the disease, but only provide protection to the brain from ischemic abnormalities. For this purpose various medications, in particular blood thinners.
Surgical. Used in situations where it is impossible to compensate for cerebral circulation in other ways. Experienced surgeons perform endovascular surgery, the meaning of which is to insert a stent into the lumen of a narrowed vessel. This is a special dilator that increases the diameter of the artery, normalizing blood flow.

To eliminate vascular manifestations, specialists prescribe drugs to patients that improve brain nutrition.

Medicines activate metabolic processes in the nervous system and protect its cells from repeated exposure to the aggressor.

Conservative treatment only relieves symptoms - the consequences of vascular damage.

Prevention

Since atherosclerosis and coronary heart disease are chronic progressive diseases, it is very important to pay sufficient attention to prevention.

After all, this is how you can prevent the disease itself, as well as slow down its progression.

the goal of such measures is to optimize the composition of arterial blood so that it does not contain factors that contribute to the formation of plaques.

Nutrition

Try not to lift or hold heavy objects with outstretched arms. You need to learn how to carry weights correctly so as not to injure your back. With an even posture, you need to squat down, take the load and straighten your legs with it.

At the same time, place your hands as close to your body as possible. Distribute the load evenly, so you don't have to carry it in one hand if you can carry two bags in both hands.

Use bags, carts, and rolling suitcases to transport heavy items.

Among the many existing pathologies, narrowing of the vertebral artery stands out in that it can be congenital or acquired in nature. The term stenosis is commonly used for narrowing of the vertebral arteries. In addition to narrowing of blood vessels, this term can mean their blockage or partial blockage.

Such pathology of the vertebral artery can cause coronary artery disease and cerebral stroke in the future. The ambiguity of therapeutic methods is complicated by the fact that early stages The disease is quite difficult to identify accompanying symptoms.

Taking medications can alleviate the patient’s condition only in 35-45% of cases. The improvement in condition is temporary and short-lived. Complete recovery occurs only as a result of surgical intervention.

What kind of disease

Literally, as a result of disturbances, stenosis leads to difficulty in blood flow, and the overall intensity of supply of nutrients and oxygen to the brain flow decreases.

Signs of narrowing of the left vertebral arteries make themselves felt after the internal space of the vascular cup narrows by more than 50-55%.

Symptoms

Since the task of the vertebral arteries is to provide at least 35-45% of the total blood supply to the brain, narrowing of the lumen causes chronic failure.

A prolonged decrease in blood flow is indicated by the following symptoms:

Periodic headaches - migraine crises occur mixed with dizziness, as well as a decrease in vision clarity.
Pain in the lumbar region is one of the primary symptoms of spinal vascular stenosis. Exacerbation occurs during walking and during physical activity.
Numbness of the limbs. With exacerbation of the pathology and progression of narrowing of the distal section, restless legs syndrome (a noticeable sensation of pins and needles), muscle weakness and tingling appears.
Increased blood pressure - pressure increases due to the body’s spontaneous attempts to establish normal blood supply to the brain.

Main reasons

There are three main reasons for the development of vertebral artery stenosis:

Congenital factor - a predisposition at the genetic level leads to congenital changes in the structural structure of blood vessels. If the disease does not enter the acute phase, people with a similar diagnosis continue to live a full life.
Acquired factor - can be attributed to the main reason causing the need to treat narrowing of the vertebral artery. The condition of blockage of blood vessels can cause diabetes, atherosclerosis and various metabolic disorders.
Traumatic factor - the artery narrows due to force (fracture, bruise, hematoma). IN mandatory Surgery to remove the cause of the blockage is recommended.

Danger of disease

It is worth judging the danger of a disease based on the location of the pathological changes. Acute stenosis of the right vertebral artery threatens with a stroke, and death is not excluded.

The progressive form of the disease is the main factor for confirming disability. Regardless of whether there was surgical intervention, a patient in the later stages of stenosis is assigned to the disability group.

Variety

Therapeutic options and possible consequences diseases largely depend on the site of its localization.

Estuary stenosis - noticeable emotional disturbances are observed: panic attacks, pressing pain in the area of the frontal lobe, photophobia, irritability. Focusing on character pathological disorders, the need for surgical intervention is determined and possible drug therapy for the preoperative period is selected.
Vertebrogenic stenosis - the main symptoms are pain syndrome in the lumbar or sacral region. This type of disease is not typical inflammatory process. MRI reveals moderate signs of atrophy of the frontal lobe of the cerebral cortex.
Subcompensated stenosis - the main reason for its appearance is the action of a traumatic factor. Drug therapy will not bring results; only surgical correction is required. Another reason may be the presence of cancer. With this diagnosis, the disease often leads to death.
Intracranial stenosis occurs in conjunction with arterial thrombosis. In the presence of unfavorable factors the disease progresses rapidly and leads to stroke.
Compensated stenosis - pathological condition the patient is hardly noticeable, acute form practically absent. The need for urgent surgery is not a priority.
Stenosis of extravasal compression of the left vertebral artery - the disease arises as a result of abnormal conditions of the spine. The reasons include hernia, osteochondrosis of the cervical spine, oncology, etc. Having overcome the underlying disease, the blood supply, as a rule, returns to normal.
Stenosis of extravasal compression of the right vertebral artery - similar diagnosis corresponds to the etiology of narrowing of the spine on the left, although it is localized on the right side.
Multifocal stenoses are vascular lesions in multiple forms. Surgery is ineffective. Clear drug therapy is indicated, and if there is no effect, angioplasty is prescribed with complete replacement of the defective sections of the arteries.
Dynamic stenosis - complete or partial occlusion of the vascular wall is observed. The condition is classified as extremely dangerous for the patient’s life. Drug therapy is aimed only at alleviating symptoms and serves mainly to prepare the patient for surgery.
Hemodynamically significant stenosis is a pathology in which the vascular lumen is narrowed by more than 50%. The consequences negatively affect blood flow to the brain.
Functional stenosis - symptoms appear only in certain postures of the cervical spine. Progression of the disease can occur in the presence of spondylosis, osteochondrosis and other pathologies of the spine.
Decompensated stenosis - pathology takes the place of extremely severe conditions. The narrowing of the lumen of blood vessels becomes irreversible, chronic. The only rational solution is complete replacement of the defective section of the artery or the formation of a backup channel.

Before choosing therapeutic methods, you must undergo differential diagnosis. This procedure will show a more accurate reason for the development of deviations, indicate the real phase and form of the disease. When determining the feasibility of surgical intervention, the main classifier is the degree of development of stenosis.

Treatment methods

Basically, one of three methods of combating the disease is used. In some cases, it is possible to use two methods of treating spinal vascular stenosis together.

Drug therapy

The method is based on the prescription and use of vascular drugs that help maintain strength and elasticity. Medicines are also prescribed to control blood pressure, thin the blood and reduce blood clots. Along with medications, courses of physical therapy are prescribed, and manual therapy and hirudotherapy are also indicated.

Surgery

This procedure is aimed at surgical correction to eliminate traumatic complications and disorders in the structure of the spine. Stenosis can also be treated with stenting. A reinforced metal frame is placed in the artery, which prevents further rupture of the narrowing vascular bed. Stents are designed for an average of 15 years of successful functioning. To reduce the risk of rejection, the steel frame is coated with special plastic.

Traditional methods of treatment

Such methods have not yet found recognition among representatives of official medicine. But, according to available data, medicinal decoctions and tinctures help to normalize vascular tone, restore preset blood circulation parameters and regulate blood pressure. As prophylactic, used to narrow the vascular systems of the vertebral arteries, folk remedies look quite effective.

To determine the optimal type of therapy, the appropriate specialist issues a referral for several diagnostic procedures. One of the most informative and reliable methods Duplex scanning of certain arteries is recognized to obtain a full-scale picture of pathological changes. As an additional option, an MRI of the area of stenosis may be prescribed.

The final decision on treatment methods should be made by the attending physician together with the patient. If the patient complains of regular dizziness, chronic shortness of breath, general weakness and irritability, and vasoconstriction is determined to be at least 70%, then these signs are a serious reason for surgery.