About Video

This video shows various steps of transesophageal echocardiographic identification of bilateral vertebral artery ostial stenosis. (Step I and II) The arrow points to stenosis at origin of the left vertebral artery (LVA) that arises from the left subclavian artery (LSA). Color Doppler-guided continuous wave Doppler interrogation of the LVA demonstrates high peak systolic and peak end-diastolic velocities of 3.8 and 1.7 m/s, respectively, indicative of severe ostial stenosis (bottom left inset in Step I). The bottom right inset in step I demonstrates normal flow velocities obtained from the LSA. The inset in Step II reveals normal flow velocities from the more distal precervical LVA segment; (step III) the arrow points to stenosis at the origin of right vertebral artery (RVA), which arises from right subclavian artery (RSA). Color Doppler-guided continuous wave Doppler interrogation of the RVA demonstrates high peak systolic and peak end-diastolic velocities of 3.7 m/s and approximately 1.2 m/s, respectively, indicative of severe ostial stenosis (inset in step III); (step IV and V) vertebral artery angiogram. FA: Flow acceleration).