Surgical reconstruction of the extracranial vertebral artery: Management and outcome

Berguer, Ramón; Flynn, Lisa; Kline, Ronald A.; Caplan, Louis R.

doi:10.1016/s0741-5214(00)70063-2

Cited by 130 publications

(86 citation statements)

References 14 publications

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“…[314][315][316][317][318][319][320][321] For proximal vertebral artery reconstruction, early complication rates of 2.5% to 25% and perioperative mortality rates of 0% to 4% have been reported. 315,316 For distal vertebral artery reconstruction, mortality rates have ranged from 2% to 8%.…”

Section: Vertebral Artery Revascularizationmentioning

confidence: 99%

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive summary

Brott

Halperin

Abbara

et al. 2011

Cathet Cardio Intervent

185

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Section: Vertebral Artery Revascularizationmentioning

confidence: 99%

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive summary

Brott

Halperin

Abbara

et al. 2011

Cathet Cardio Intervent

185

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“…88 Angiography often showed occlusion of the ECVA at its origin, with well-developed collateral circulation from the external carotid and the thyrocervical and costocervical arteries ( Figure 9). ECVA surgery can be performed safely by surgeons experienced in the procedure, 89 but we still do not know which patients are surgical candidates. Angioplasty is also possible, but indications, risks, and benefits have not been studied.…”

Section: Vascular Occlusive Lesionsmentioning

confidence: 99%

Posterior Circulation Ischemia: Then, Now, and Tomorrow

Caplan

2000

Stroke

Self Cite

173

103

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know and appreciate where we are now and where we are going in the future, it is essential to know where we have been. We cannot afford to relive and repeat the history of stroke every several decades. Posterior circulation stroke represents a microcosm of stroke in general. In this presentation I first review the development of ideas regarding brain and posterior circulation ischemia and its recognition and treatment. I then share some recent data from a large prospective registry of patients with posterior circulation ischemia. Finally, I look ahead to reflect on what I believe should be the future directions for research and for the care of patients with posterior circulation disease.Patients who present to physicians and hospitals with symptoms that suggest posterior circulation ischemia are handled differently from patients who have symptoms that suggest anterior circulation disease in the great majority of medical facilities in the United States and in the world. A patient who has an attack of dizziness with diplopia and ataxic gait usually has a brain image but seldom has vascular or cardiac investigations. A diagnosis of "vertebrobasilar insufficiency" (VBI) is often made, and physicians then debate whether or not to treat with warfarin-type anticoagulants, and, if so, for how long and at what intensity. In contrast, a patient who has right-hand weakness and aphasia is usually evaluated and treated quite differently at the very same facilities. Brain imaging, cardiac investigations, noninvasive vascular tests of the carotid and intracranial anterior circulation with the use of extracranial and transcranial ultrasound and/or MR angiography (MRA) and CT angiography, and catheter angiography are often pursued, depending on the local technological capabilities and experience of the treating physicians. An effort is made to identify the etiology and mechanism of the ischemia. Treatment is then chosen among a variety of possibilities (including carotid artery surgery, angioplasty, anticoagulants, and antiplatelet aggregants) depending on the nature, location, and severity of the occlusive disease and the mechanism of ischemia.Why should anterior and posterior circulation ischemia be handled so differently? Does this schizophrenic approach make sense? After all, the internal carotid artery and its branches and the vertebral (VA) and basilar arteries (BA) and their branches are just a few inches apart; they are made of the same coats and look the same under the microscope except for size. These vessels carry the same blood under the same blood pressure. The diseases that affect the blood vessels in the 2 circulations are the same. Do stroke mechanisms really differ between the 2 circulations? How did this differing approach originate, and does it continue to make sense today? These are some questions that I will attempt to answer as I review the development of ideas about posterior circulation ischemia and as I report recent data. Development of IdeasHerein I review how knowledge about the posterior circulation ...

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“…Of those patients with 5 years of follow-up after microsurgical intervention, 97% remained stroke free. 2 In the present series, in a mean follow-up period of 8.8 months, 1 patient had restenosis 3 months after the microvascular procedure and required endovascular stenting.…”

Section: Discussionmentioning

confidence: 52%

“…Their angiographic results showed only 1 case of recurrent stenosis among those patients who underwent follow-up imaging. Berguer et al 2 reported a 71% 5-year survival rate for patients with extracranial VA disease undergoing microsurgical revascularization. A majority of the patients who died did so as a result of cardiac disease.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Vertebral artery transposition for revascularization of the posterior circulation: a critical assessment of temporary and permanent complications and outcomes

Rangel-Castilla¹,

Kalani²,

Cronk³

et al. 2015

JNS

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P osterior circulation infarction accounts for 25%-30% of all ischemic infarcts.3 After the carotid bifurcation, the proximal vertebral artery (VA) is the most common site of stenosis of the feeding vessels to the brain. 15 Unlike the carotid bifurcation, stenosis of the proximal VA that exceeds 30% is significantly associated with infarction in the posterior circulation 21 and large-vessel occlusive disease is implicated in 14%-32% of infarctions in the posterior circulation. 3,4 Unlike the carotid circulation, for which the natural history of stenosis is well understood, the natural history of vertebrobasilar insufficiency is less well known. Furthermore, the effect of novel agents, including antiplatelet agents and statins, on altering the natural history of these lesions is less well studied. Recent attempts at the use of stenting and/or angioplasty for these lesions has produced mixed results 1,8,26,27 and significant rates of restenosis, ranging from 11% for drug-eluting stents to more than 30% for bare-metal stents.Microsurgical revascularization of the proximal VA has been well described, but the majority of published series included small patient populations and short follow-up ObJect Despite advances in medical management and endovascular therapies, including the introduction of statins, antiplatelet agents, and drug-eluting stents, some patients experience medically refractory vertebrobasilar insufficiency and may benefit from robust surgical revascularization. The aim of this study was to evaluate such patients after surgical revascularization, emphasizing long-term outcomes and rates of complications. MethODS The authors retrospectively identified 22 patients (5 women and 17 men) whose mean age was 69.1 years (range 48-81 years) who underwent revascularization of the posterior circulation via a proximal vertebral artery-carotid artery transposition between 2005 and 2013. The patients' conditions before surgery were clinically summarized, and long-term outcomes and complication rates after surgery were evaluated. reSultS All the patients were symptomatic before surgery although they received the best medical therapy as defined by their primary care physician. Presenting symptoms consisted of stroke, transient ischemic attacks (TIAs), and/or findings attributable to posterior circulation hypoperfusion. There were no deaths associated with revascularization surgery. The postoperative complication rate was 45.5%, which included 3 cases of recurrent laryngeal nerve palsy, 1 case of thoracic duct injury, 2 cases of TIA, and 4 cases of Horner's syndrome. The thoracic duct injury was identified intraoperatively and ligated without sequelae, all the TIAs resolved within 24 hours of surgery, all 4 sympathetic plexus injuries resolved, and all but 1 of the recurrent laryngeal nerve palsies resolved, resulting in a 4.5% complication rate in a mean follow-up period of 8.8 months. All the patients had resolution of their presenting symptoms, and a single patient had symptomatic restenosis that required stenting a...

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Surgical reconstruction of the extracranial vertebral artery: Management and outcome

Cited by 130 publications

References 14 publications

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive summary

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive summary

Posterior Circulation Ischemia: Then, Now, and Tomorrow

Vertebral artery transposition for revascularization of the posterior circulation: a critical assessment of temporary and permanent complications and outcomes

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