Vertebral Artery Reimplantation into the Common Carotid Artery

Abstract

Vertebral arteries are variable in size in 80–85% individuals with one artery maybe larger and dominant, and the other may be hypoplastic. Approximately 25% of all ischemic strokes in the brain are in the vertebral-basilar territory secondary to hypoperfusion. A single vertebral artery is sufficient to perfuse the basilar artery. Vertebral artery reimplantation into the common carotid artery is indicated in patients with vertebral-basilar insufficiency (drop attacks, dizziness, dysarthria, and ataxia) associated with high-grade stenosis at the origin of the vertebral artery with contralateral vertebral artery being occluded or hypoplastic or severely stenotic. Through a supraclavicular incision, dissection is done between the two heads of sternomastoid with retraction of the internal jugular vein laterally. Common carotid artery with vagus nerves is retracted medially. Thoracic duct on the left side is ligated and divided, and the origin of the vertebral artery is transected with ligation of the proximal end. The vertebral artery is spatulated, and reimplantation is performed on to the posterolateral wall of the common carotid artery.