Microsurgical revascularization of proximal vertebral artery: a single-center, single-operator analysis

High rates of restenosis after stenting to treat vertebral artery (VA) origin disease have revitalized interest in microsurgical revascularization for this condition. This study analyzes the outcomes of microsurgical revascularization used to treat proximal VA occlusive disease.

Between 1986 and 2007, 29 patients (19 men, 10 women; age range, 35-93 years) underwent microsurgical revascularization for proximal VA disease. Their medical records were reviewed retrospectively for presenting symptoms, presence of comorbidities, target lesion characteristics, contralateral VA findings, procedure-related morbidity, and clinical and radiographic outcomes.

Thirteen, 7, and 6 patients underwent VA-to-carotid artery transposition, endarterectomy, or both, respectively. Two patients underwent subclavian endarterectomy plus vertebral endarterectomy, and 1 patient underwent carotid endarterectomy associated with VA transposition. There were no cases of periprocedural stroke or death. Permanent procedure-related neurological complications included 1 case of Horner's syndrome and 1 case of hoarseness. Two of the 27 patients available for follow-up had new neurological symptoms attributable to the vertebrobasilar system. Follow-up imaging was available for 14 patients, only 1 of whom developed restenosis, most likely related to disease progression at the site of anastomosis.

Microsurgical revascularization is a good alternative treatment for proximal VA occlusive disease. Randomized studies are needed to compare the efficacy of surgical revascularization and stenting, especially drug-eluting stents, for this indication.