RadioGraphics -- eLetters for Romero et al., 22 (5) 1165-1176

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RSNA Education Exhibits:
Javier M. Romero, Michael H. Lev, Suk-Tak Chan, Molly M. Connelly, Ryan C. Curiel, Anna E. Jackson, R. Gilberto Gonzalez, and Robert H. Ackerman
US of Neurovascular Occlusive Disease: Interpretive Pearls and Pitfalls
Radiographics 2002; 22: 1165-1176 [Abstract] [Full text] [PDF]

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Electronic letters published:

US Doppler in Vertebral Artery: Francisco Campoy-Balbontin (21 March 2003)

US Doppler in Vertebral Artery 21 March 2003

Francisco Campoy-Balbontin,
Attending Radiologist
Radiology Department. La merced Hospital. Osuna (Sevilla-Spain)
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Re: US Doppler in Vertebral Artery

fcampoy2000{at}hotmail.com Francisco Campoy-Balbontin

I read with interest the article by Romero et al (1). One of the interpretative pearls mentioned is under the heading: "Abnormally Low Resistance Waveforms and Persistent Trigeminal Artery," where the authors describe the low resistance at the internal carotid artery, a consequence of bridging of the carotid and basilar arterial territories in the fetal cerebral circulation. They do not, however, mention the vertebral artery, and it probably should be another pearl because the vertebral artery would receive two pulsatile waves, the first from the subclavian artery and the second from the trigeminal artery, accessory branch of the internal carotid artery, in such a way that they would simulate a subclavian steal or a venous pulse with absence of a vertebral wave.
Reference
1. Romero JM, Lev MH, Chan ST, et al. US of neurovascular occlusive disease: interpretive pearls and pitfalls. RadioGraphics 2002; 22:1165-1176.
Dr Romero responds:
I appreciate Dr Campoy-Balbontin’s interest in the subject and I agree with him that the phenomenon he describes will occur if the patient has fully developed vertebral arteries. However, since this abnormality is congenital and usually develops before the posterior circulation reaches full development, the vertebral arteries and the proximal basilar artery are frequently atretic and have high resistance, which does not permit substantial retrograde flow. If the posterior circulation has reached an appropriate level of development, a biphasic waveform can occur. The case we described was reviewed and high resistant antegrade waveforms in the vertebral arteries were noted.