Vertebral Artery Revascularization

Abstract

The vertebrobasilar arterial system represents an important inflow to the brain regarding not only the vascularization of vital regions and centers but also the extent of the territory of vascularization. It is worthwhile noticing that about 20 % of the ischemic events in the brain occur in the vertebrobasilar system. The clinical picture is multifaceted and protean and many times overlooked in the context of concomitant carotid artery stenosis. Not least, less attention is given to the vertebrobasilar system as many physicians still consider that the symptoms in the posterior circulation will amend after correction of the carotid lesion(s). Ischemia in the vertebrobasilar system is caused mainly by occlusive disease or dissection of the VA, BT, and PCA and by cardioembolism or artery-to-artery embolism (from aorta or VA). Particular conditions are represented by dolichoectasia (dilatative arteriopathy) and the subclavian steal syndrome (vertebral steal). Dolichoectasia comprises arterial elongation, widening, and tortuosity [1, 2] eventually leading to brain ischemia, compression of the cranial nerves, and arterial rupture and hemorrhage. The subclavian/vertebral steal syndrome is a cause of intermittent brain ischemia accompanied by signs of superior limb ischemia in case of severe stenosis or occlusion of the subclavian artery (or BCT). It is interesting to note the fact that vertebral steal can occur even if the V0 and V1 segments are occluded, through developed collaterals between the V3 and SCA or ECA.