Surgical management of extracranial vertebral artery occlusive disease

G. P. Deriu, E. Ballotta, L. Franceschi, F. Grego, D. Cognolato, A. Saia, L. Bonavina

Research output: Contribution to journalArticlepeer-review

Abstract

Thirty-seven consecutive patients underwent vertebral artery (VA) reconstruction over a 6 years period (1983-1989). Detailed neurologic, medical, and angiographic information was obtained for all patients. Indications for surgery were as follows: (1) stenosis of VA with symptoms of vertebrobasilar insufficiency; (2) very tight stenosis (greater than 75%) of the dominant VA with stenosis or occlusion of the contralateral VA; (3) very tight stenosis of VA with bilateral occlusion of the internal carotid artery (ICA); (4) very tight stenosis of VA with homolateral ICA lesion eligible for simultaneous repair; (5) very tight stenosis of VA and very tight stenosis of the homo or contralateral carotid siphon. There were 15 isolated vertebral lesions (group I), and 22 were VA lesions associated with lesions of the supraaortic trunks which were simultaneously treated (group II). The reconstructions of the first portion of the VA were 30 (12 of group I and 18 of group II) and reimplantation of the VA into the common carotid artery was the procedure of choice. There were 7 revascularizations of the third portion of the VA at C1-C2 level (3 of group I and 4 of group II): carotid-vertebral bypass, using an autogenous vein graft, was the procedure of choice. Three patients in group II died in the immediate postoperative period from myocardial infarction but no patient presented immediate postoperative neurologic deficits. All symptomatic patients but one were relieved of their symptoms in a median follow up of 31 months. No postoperative complications were observed. Long-term results were satisfactory in all the 28 patients at their last follow-up visit. There were 4 late deaths: 3 in group I from myocardial infarction after 32, 23 and 11 months respectively and one patient in group II after 41 months from an unknown cause. We conclude that: (1) isolated VA revascularization is an effective surgical procedure with a very low peroperative risk and very gratifying long-term results; (2) combined carotid and VA surgery does not increase postoperative mortality and neurological morbidity; (3) indications for VA surgery may be extended to include presumably asymptomatic VA lesions on the same side of symptomatic and asymptomatic carotid stenosis requiring surgical correction.

Original languageEnglish
Pages (from-to)413-419
Number of pages7
JournalJournal of Cardiovascular Surgery
Volume32
Issue number4
Publication statusPublished - 1991

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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