Distal vertebral artery revascularization

Abstract

The course of vertebral artery (VA) between its origin and formation of basilar artery is anatomically divided into four segments. The first segment, V1, is between the origin from subclavian artery and entry into transverse foramen of C5/C6 vertebra. The second segment, V2, is its course inside the vertebral foramina from C6 to C2. The third segment, V3, is distal extracranial segment, where it runs laterally and posteriorly to turn at a right angle around the atlas to continue intracranially through the atlanto-occipital membrane. The fourth segment, V4, of the VA extends from the dural entrance point to the vertebrobasilar junction. It may be involved by vascular or neoplastic pathology, which may require a replacement of the artery or a direct repair. This chapter deals with the current indications and techniques for such a repair. There are three primary pathologies, which may necessitate such a repair, namely, neoplasms (especially meningioma and recurrent chordoma), dissection (also called dissecting aneurysm), and complex or fusiform aneurysms, which cannot be easily treated by an endovascular technique.