Microsurgical revascularization of a symptomatic proximal vertebral artery: pilot experiences from a single center

Abstract

BackgroundVertebral artery stenosis and occlusion (VASO) is a high-risk factor for posterior circulation stroke. Post-stent restenosis and drug tolerance have facilitated the exploration of microsurgical vascular reconstruction. This study aims to evaluate the safety and efficacy of microsurgical reconstruction of the proximal VA.MethodsTwenty-nine patients (25 men, aged 63.2 years) who had symptoms of posterior circulation ischemia underwent microsurgical revascularization for proximal VASO were retrospectively included in this study. Procedural complications and clinical and angiographic outcomes were reviewed.ResultsTwelve, three, and five patients underwent VA endarterectomy, artery transposition, or both, respectively; seven patients underwent vertebral endarterectomy plus stent implantation; and two patients failed surgery because of the difficult exposure of the VA and the occurrence of vascular dissection. The perioperative period-related complications included seven cases of Horner’s syndrome, five cases of hoarseness, and one case of chylothorax. No cases of perioperative stroke or death were reported. The mean follow-up period was 28.4 (8–62 months). Most patients improved clinically; however, the vertebrobasilar ischemia symptoms did not decrease significantly in two patients during the follow-up. Moreover, follow-up imaging was performed in all the patients, and no signs of anastomotic stenosis were reported.ConclusionMicrosurgical reconstruction is an alternative option that can effectively treat refractory proximal VASO disease and in-stent stenosis, with a high rate of postoperative vascular recirculation. Prospective cohort studies with larger sample sizes must be conducted to validate the above conclusions.

A case report of high cervical spinal infarction after stenting with severe stenosis at the beginning of left vertebral artery

“…A Shandong University study evaluating the safety and effectiveness of microsurgical reconstruction of the proximal VA surface, Microsurgical reconstruction is an alternative option for effective treatment of refractory proximal VASO disease and in-stent stenosis, with a high rate of postoperative vascular reciraturation. [27] This suggests that the operator may try the transradial approach or vertebral endarterectomy under appropriate circumstances as an option when stent angioplasty of vertebral artery ostial stenosis via femoral artery approach is difficult.…”