Transcervical Vertebral Artery Origin Endarterectomy for Vertebrobasilar Insufficiency

Area of Science:

• Vascular Surgery
• Neurology
• Interventional Cardiology

Background:

• Vertebral artery (VA) stenosis is a significant cause of vertebrobasilar insufficiency (VBI) and posterior circulation stroke.
• Strokes in the basilar circulation can lead to more severe disability than anterior circulation strokes.
• Stenosis greater than 30% at the VA origin increases stroke risk.

Observation:

• A case is presented of a female patient with peripheral vascular disease experiencing VBI symptoms.
• Angiography revealed bilateral VA origin stenosis, with a diminutive left VA arising from the aortic arch.
• The right VA had critical stenosis at its origin, and endovascular stenting attempts were unsuccessful.

Findings:

• A transcervical endarterectomy was performed to address the critical right VA origin stenosis.
• The procedure involved accessing the V1 segment of the VA via a supraclavicular incision.
• The patient remained on heparin and antiplatelet medications during the surgery.

Implications:

• Surgical intervention, such as endarterectomy, can be a viable option for treating complex VA stenosis when endovascular methods are not feasible.
• The transcervical approach offers a direct method for accessing and treating VA origin stenosis.
• Alternative surgical strategies include patch grafting or vein grafting for VA stenosis.