title: Origin and course of the extracranial vertebral artery: CTA findings and embryologic considerations.
abstract: OBJECTIVE
  The aim of this study was to show the different origins and courses of the extracranial VA on CTA with special emphasis on embryological considerations. The duplicated VA is an anomaly that has been assumed to predispose for dissection and to be associated with aneurysms. We report its frequency and clinical significance.
  
  
  METHODS
  We retrospectively reviewed CTA of 539 patients by using a contrast-enhanced CTA protocol of the VA on CT.
  
  
  RESULTS
  Ninety-four-point-two percent of left VA originated from left subclavian artery and entered the transverse foramen at C6 in nearly all cases. Six-point-three-percent of left VA (m = 4 %, f  = 10 %) originated from the aortic arch and entered the transverse foramen either at C4, C5 or C7 but never at C6. One case of an aberrant retroesophageal right VA originated from the aortic arch distal to the left subclavian artery and entered at C7 (0.19 %). All other right VA originated from the right subclavian artery (99.8 %) and entered between C4 and C6. We diagnosed four cases of duplicated VA (0.74 %) with a female predominance (1.9 %) without any signs of dissection on CTA. Two cases with VA duplication had intracranial arterial aneurysms.
  
  
  CONCLUSIONS
  The VA is a longitudinal anastomosis of segmental metameric arteries. The level of entrance into the transverse foramen indicates which metameric artery or arteries persist. Duplication corresponds to persistence of two segmental arteries and is a rare phenomenon. VA duplication might be associated with vascular lesions.
authors.affiliation: Department of Radiology and Neuroradiology, Klinikum Duisburg-Sana Kliniken, Duisburg, Germany. dan.meila@sana.de
authors.forename: D
authors.initials: D
authors.lastname: Meila
authors.forename: M
authors.initials: M
authors.lastname: Tysiac
authors.forename: M
authors.initials: M
authors.lastname: Petersen
authors.forename: O
authors.initials: O
authors.lastname: Theisen
authors.forename: A
authors.initials: A
authors.lastname: Wetter
authors.forename: A
authors.initials: A
authors.lastname: Mangold
authors.forename: M
authors.initials: M
authors.lastname: Schlunz-Hendann
authors.forename: K
authors.initials: K
authors.lastname: Papke
authors.forename: F
authors.initials: F
authors.lastname: Brassel
authors.forename: A
authors.initials: A
authors.lastname: Berenstein
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D000783:Aneurysm / Q000000981:diagnostic imaging / Q000196:embryology; D001013:Aorta, Thoracic / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000196:embryology; D002533:Cerebral Angiography; D003287:Contrast Media; D005260:Female; D006801:Humans; D007472:Iohexol / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000196:embryology; D013348:Subclavian Artery / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000196:embryology; D014711:Vertebral Artery / Q000002:abnormalities / Q000000981:diagnostic imaging* / Q000196:embryology*; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging / Q000196:embryology
chemical_list: D003287:Contrast Media; D007472:Iohexol; C038192:iopromide