Summary
For vascular reconstruction in cases of atherosclerotic stenosis at the origin of the vertebral artery, we use vertebral to subclavian artery transposition. We discuss the advantages and effectiveness of such treatment based on a study of 32 cases. We have experienced neither surgical mortality nor morbidity and the outcome at the time of discharge has been favourable. Follow-up revealed no deaths, however, three cases exhibited symptoms of cerebral ischaemia. One had a supratentorial completed stroke, and the other two hat TIA or RIND, but without any notable lesion in the angiograms. There were no cases of cerebral infarction of the posterior fossa.
We believe that this method should be the first choice for treatment of cases without lesions of the subclavian artery for the following reasons: serious operative complications have not been encountered, surgical invasion is minimal, temporary occlusion of the common carotid artery is unnecessary, the operation can be done by occluding only the vertebral artery, and unlike various bypass operations, anastomosis is required at only one location and is consequently technically uncomplicated. Following anastomosis the cerebral blood pathway is physiological.
Similar content being viewed by others
References
Baker NH, Ewy HG, Moore PJ, Thomas JW, Sanfelippo PM, Brahos GJ, McVicker RF (1986) Direct internal mammaryvertebral artery anastomosis: An 18-year follow-up. J Thoracic Cardiovasc Surg 92: 1103–1105
Berguer R, Andaya LV, Bauer RB (1976) Vertebral artery bypass. Arch Surg 111: 976–979
Berguer R, Bauer RB (1981) Vertebral artery reconstruction. A successful technique in selected patients. Ann Surg 441–447
Camp PE (1984) Carotid to distal vertebral artery bypass for vertebrobasilar ischaemia. J Neurosurg 60: 187–189
Cartilidge NEF, Whisnant JP, Elveback LR (1977) Carotid and vertebral-basilar transient ischaemic attacks. A community study, Rochester, Minnesota. Mayo Clin Proc 52: 117–120
Gate WR, Scott HW (1959) Cerebral ischaemia of central origin: Relief by subclavian-vertebral artery thrombonendarterectomy. Surgery 45: 19–31
Corkill G, French BN, Michas C, Cobb CA, Mims TJ (1977) External carotid-vertebral artery anastomosis for vertebrobasilar insufficiency. Surg Neurol 7: 109–115
Cormier JM, Laurian C (1976) Surgical management of vertebral-basilar insufficiency. J Cardiovasc Surg 17: 205–223
Cormier JM, Laurian C (1976) Surgical management of vertebral-basilar insufficiency. International Surgery 61: 203–212
Crawford ES, De Bakey ME, Fields WS (1958) Roentgenographic diagnosis and surgical treatment of basilar artery insufficiency. JAMA 168: 509–514
De Bakey ME, Crawford ES, Cooley DA, Morris GC (1959) Surgical considerations of occlusive disease of innominate, carotid, subclavian and vertebral arteries. Ann Surg 149: 690–710
De Bakey ME, Crawford S, Morris GC, Cooley DA (1961) Surgical considerations of occlusive disease of the innominate, carotid, subclavian, and vertebral arteries. Ann Surg 154: 698–725
Diaz FG, Ausman JI, Reyes RAD, Pearce J, Shrontz C, Pak H, Turcotte J (1984) Surgery reconstruction of the proximal vertebral artery. J Neurosurg 61: 874–881
Edwards WH, Wright RS (1972) Current concepts in the management of arteriosclerotic lesions of subclavian and vertebral arteries. Ann Surg 175: 975–984
Edwards WH, Mulherin JL (1980) The surgical approach to significant stenosis of vertebral and subclavian arteries. Surgery 87: 20–28
Edwards WH, Mulherin JL (1980) The surgical management of proximal subclavian-vertebral artery stenosis. Contemp Surg 17: 11–19
Edwards WH, Mulherin JL (1985) The surgical reconstruction of the proximal subclavian and vertebral artery. J Vasc Surg 2: 634–642
George B, Laurian C (1982) Vertebro-basilar ischaemia. Acta Neurochir (Wien) 62: 287–295
Imparato AM, Lin JP-T (1967) Vertebral arterial reconstruction: Internal plication and vein patch angioplasty. Ann Surg 166: 213–221
Javid H (1966) Appraisal of progress in surgical therapy. Surg 59: 1147–1153
Kojima T, Waga S, Kanemaru K (1983) Anastomosis of the superior thyroid artery to the vertebral artery for vertebrobasilar insuficiency. Surg Neurol 20: 481–486
Lord RSA (1973) Vertebrobasilar ischaemia and the extracranial arteries. Med J Australia 7: 32–37
Luosto R, Harjola P-T, Ketonen P, Tala P (1976) Operative treatment of atherosclerotic lesions in innominate, subclavian and vertebral arteries. Ann Chir Gynecol 65: 153–157
Malone JM, Moore WS, Hamilton R, Smith M (1980) Combined carotid-vertebral vascular disease. Arch Surg 115: 783–785
Myers KA (1977) Reconstruction of vertebral artery stenosis. Aust NZ Surg 47: 41–48
Natali J, Maraval M, Kieffer E (1972) Surgical treatment of stenosis and occlusion of the internal carotid and vertebral arteries. J Cardiovasc Surg 13: 4–15
Ogawa A, Suzuki J, Yoshimoto T (1986) Acute revascularization for major stroke and progressing stroke with Sendai cocktail and perfluorochemicals. In: Gagriardi R, Benvenuti L (eds) Controversies in EIAB for cerebral ischaemia. Mondussieditore, Bologna, pp 451–458
Ogawa A, Sakurai Y, Kayama T, Wada T, Suzuki J (1987) Revascularization for vertebro-basilar occlusive disease. In: Gagriardi R, Benvenuti L (eds) Controversies in EIAB for cerebral ischaemia. Bologna, Mondussieditore, pp 489–498
Ogawa A, Sakurai Y, Kayama T, Yoshimoto T, Suzuki J (1988) Revascularization for vertebro-basilar occlusive disease. Neurol Surg (Tokyo) 16: 149–155
Pritz MB, Chandler WF, Kindt GW (1981) Vertebral artery disease: Radiological evaluation, medical management, and microsurgical treatment. Neurosurg 9: 524–530
Rainer WG, Quinazon EP, Liggett MS, Newby JP, Bloomquist CD (1970) Surgical considerations in the treatment of vertebrobasilar arterial insufficiency. Am J Surg 120: 594–597
Reul GJ, Cooley DA, Olson SK, Hallman GL, Frazier OH, Ott DA, Duncan JM, Livesay JJ (1984) Long-term results of direct vertebral artery operations. Surg 96: 854–862
Roon AJ, Ehrenfeld WK, Cooke PB, Wylie EJ (1979) Vertebral artery reconstruction. Am J Surg 138: 29–36
Senter HJ, Bitter SM, Long ET (1985) Revascularization of the extracranial vertebral artery at any level without cross-clamping. J Neurosurg 62: 334–339
Spetzler RF, Hadley MN, Martin NA, Hopkins LN, Carter LP, Budny J (1987) Vertebrobasilar insufficiency. Part 1: Microsurgical treatment of extracranial vertebrobasilar disease. J Neurosurg 66: 648–661
Suzuki J, Yoshimoto T (1979) The effect of mannitol in prolongation of permissible occlusion time of cerebral artery-clinical data of aneurysm surgery. Neurosurg Rev 1: 13–19
Suzuki J, Yoshimoto T, Kodama N,etal (1982) A new therapeutic method for acute brain infarction: Revascularization following the administration of mannitol and perfluorochemicals-A preliminary report. Surg Neurol 17: 325–332
Suzuki J, Fujimoto S, Mizoi K, Yoshimoto T(1984) The protective effect of combined administration of antioxidants and perfluorochemicals on cerebral ischaemia. Stroke 15: 672–679
Suzuki J, Imaizumi S, Kayama T, Yoshimoto T (1985) Chemiluminescence in hypoxic brain. The second report: Cerebral protective effect of mannitol, vitamin E and glucocorticoid. Stroke 16: 695–700
Suzuki J, Abiko H, Mizoi K, Yoshimoto T (1987) Protective effect of phenytoin and its enhanced action by combined administration with mannitol and vitamin E in cerebral ischaemia. Acta Neurochir (Wien) 88: 56–64
Thevenet A, Ruotolo C (1985) Surgical repair of vertebral artery stenoses. J Cardiovasc Surg 25: 101–110
Uenohara H, Imaizumi S, Suzuki Y, Yoshimoto T (1988) The protective effect of mannitol, vitamin E and glucocorticoid on ischaemic brain injury: evaluation by chemiluminescense, energy metabolism and water content. Neurol Res 10: 73–80
Wright RS, Edwards WH (1973) Extrathoracic surgical correction of proximal subclavian and vertebral occlusive disease. South Med J 66: 1019–1025
Wylie EJ, Effeney DJ (1979) Surgery of the aortic arch branches and vertebral arteries. Surg Clin North Am 59(4): 669–680
Yoshimoto T, Sakamoto T, Watanabe T, Suzuki J (1978) Experimental cerebral infarction. Part 3: Protective effect of mannitol in thalamic infarction in dogs. Stroke 9: 217–218
Yoshimoto T, Ogawa A, Suzuki J (1988) Acute stage revascularization under administration of new cerebral protective agent, “Sendai Cocktail”. In: Suzuki J (ed) Advances in surgery for cerebral ischaemia. Springer, Tokyo, pp 559–562
Ziegler DK, Hassaanein RS (1973) Prognosis in patients with transient ischaemic attacks. Stroke 4: 666–673
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Ogawa, A., Yoshimoto, T. & Sakurai, Y. Treatment of proximal vertebral artery stenosis. Acta neurochir 112, 13–18 (1991). https://doi.org/10.1007/BF01402448
Issue Date:
DOI: https://doi.org/10.1007/BF01402448