Skip to main content
SpringerLink
Log in

Treatment of proximal vertebral artery stenosis

Vertebral to subclavian transposition

  • Clinical Articles
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. 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

    Google Scholar 

  2. Berguer R, Andaya LV, Bauer RB (1976) Vertebral artery bypass. Arch Surg 111: 976–979

    PubMed  Google Scholar 

  3. Berguer R, Bauer RB (1981) Vertebral artery reconstruction. A successful technique in selected patients. Ann Surg 441–447

  4. Camp PE (1984) Carotid to distal vertebral artery bypass for vertebrobasilar ischaemia. J Neurosurg 60: 187–189

    PubMed  Google Scholar 

  5. 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

    PubMed  Google Scholar 

  6. Gate WR, Scott HW (1959) Cerebral ischaemia of central origin: Relief by subclavian-vertebral artery thrombonendarterectomy. Surgery 45: 19–31

    PubMed  Google Scholar 

  7. Corkill G, French BN, Michas C, Cobb CA, Mims TJ (1977) External carotid-vertebral artery anastomosis for vertebrobasilar insufficiency. Surg Neurol 7: 109–115

    PubMed  Google Scholar 

  8. Cormier JM, Laurian C (1976) Surgical management of vertebral-basilar insufficiency. J Cardiovasc Surg 17: 205–223

    Google Scholar 

  9. Cormier JM, Laurian C (1976) Surgical management of vertebral-basilar insufficiency. International Surgery 61: 203–212

    PubMed  Google Scholar 

  10. Crawford ES, De Bakey ME, Fields WS (1958) Roentgenographic diagnosis and surgical treatment of basilar artery insufficiency. JAMA 168: 509–514

    Google Scholar 

  11. 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

    PubMed  Google Scholar 

  12. 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

    PubMed  Google Scholar 

  13. 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

    PubMed  Google Scholar 

  14. Edwards WH, Wright RS (1972) Current concepts in the management of arteriosclerotic lesions of subclavian and vertebral arteries. Ann Surg 175: 975–984

    PubMed  Google Scholar 

  15. Edwards WH, Mulherin JL (1980) The surgical approach to significant stenosis of vertebral and subclavian arteries. Surgery 87: 20–28

    PubMed  Google Scholar 

  16. Edwards WH, Mulherin JL (1980) The surgical management of proximal subclavian-vertebral artery stenosis. Contemp Surg 17: 11–19

    Google Scholar 

  17. Edwards WH, Mulherin JL (1985) The surgical reconstruction of the proximal subclavian and vertebral artery. J Vasc Surg 2: 634–642

    PubMed  Google Scholar 

  18. George B, Laurian C (1982) Vertebro-basilar ischaemia. Acta Neurochir (Wien) 62: 287–295

    Google Scholar 

  19. Imparato AM, Lin JP-T (1967) Vertebral arterial reconstruction: Internal plication and vein patch angioplasty. Ann Surg 166: 213–221

    PubMed  Google Scholar 

  20. Javid H (1966) Appraisal of progress in surgical therapy. Surg 59: 1147–1153

    Google Scholar 

  21. 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

    PubMed  Google Scholar 

  22. Lord RSA (1973) Vertebrobasilar ischaemia and the extracranial arteries. Med J Australia 7: 32–37

    Google Scholar 

  23. 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

    Google Scholar 

  24. Malone JM, Moore WS, Hamilton R, Smith M (1980) Combined carotid-vertebral vascular disease. Arch Surg 115: 783–785

    PubMed  Google Scholar 

  25. Myers KA (1977) Reconstruction of vertebral artery stenosis. Aust NZ Surg 47: 41–48

    Google Scholar 

  26. 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

    Google Scholar 

  27. 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

    Google Scholar 

  28. 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

    Google Scholar 

  29. Ogawa A, Sakurai Y, Kayama T, Yoshimoto T, Suzuki J (1988) Revascularization for vertebro-basilar occlusive disease. Neurol Surg (Tokyo) 16: 149–155

    Google Scholar 

  30. Pritz MB, Chandler WF, Kindt GW (1981) Vertebral artery disease: Radiological evaluation, medical management, and microsurgical treatment. Neurosurg 9: 524–530

    Google Scholar 

  31. 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

    PubMed  Google Scholar 

  32. 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

    Google Scholar 

  33. Roon AJ, Ehrenfeld WK, Cooke PB, Wylie EJ (1979) Vertebral artery reconstruction. Am J Surg 138: 29–36

    PubMed  Google Scholar 

  34. Senter HJ, Bitter SM, Long ET (1985) Revascularization of the extracranial vertebral artery at any level without cross-clamping. J Neurosurg 62: 334–339

    PubMed  Google Scholar 

  35. 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

    PubMed  Google Scholar 

  36. 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

    Google Scholar 

  37. 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

    PubMed  Google Scholar 

  38. 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

    PubMed  Google Scholar 

  39. 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

    PubMed  Google Scholar 

  40. 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

    Google Scholar 

  41. Thevenet A, Ruotolo C (1985) Surgical repair of vertebral artery stenoses. J Cardiovasc Surg 25: 101–110

    Google Scholar 

  42. 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

    PubMed  Google Scholar 

  43. Wright RS, Edwards WH (1973) Extrathoracic surgical correction of proximal subclavian and vertebral occlusive disease. South Med J 66: 1019–1025

    PubMed  Google Scholar 

  44. Wylie EJ, Effeney DJ (1979) Surgery of the aortic arch branches and vertebral arteries. Surg Clin North Am 59(4): 669–680

    PubMed  Google Scholar 

  45. 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

    PubMed  Google Scholar 

  46. 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

    Google Scholar 

  47. Ziegler DK, Hassaanein RS (1973) Prognosis in patients with transient ischaemic attacks. Stroke 4: 666–673

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Stroke Center, Sendai National Hospital, Sendai, Japan

    A. Ogawa, T. Yoshimoto & Y. Sakurai

  2. Division of Neurosurgery, Institute of Brain Diseases, Tohoku University, School of Medicine, Sendai

    A. Ogawa & T. Yoshimoto

Authors
  1. A. Ogawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Yoshimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Y. Sakurai
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints 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

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01402448

Keywords

Search

Navigation