[Indications for revascularization of the distal cervical vertebral artery]

Since the development of the technique of revascularizing the vertebral artery in its transversal and suboccipital portions, 22 revascularisation procedures of the distal vertebral artery (above C2) have been carried out in 21 patients. The earliest cases have been followed up for more than 4 years and the technique has proved to be reliable, both from the clinical and anatomical points of view. The indications were based on restoration of the vertebral axis compromised by major lesions (stenosis: 2 cases, occlusion: 14 cases) of both vertebral arteries (13 cases) or of the dominant vertebral artery in symptomatic patients (3 cases). Surgery was also offered to preserve a vascular axis which had to be sacrificed for the treatment of potentially embolic disease (aneurysm or dissection: 3 cases) or hypervascular lesions (arteriovenous malformation, tumour: 2 cases). However, the indications for distal cervical vertebral artery revascularization should be carefully considered as it is impossible to evaluate the long-term tolerance of major vertebral arterial lesions.