Revascularization of the extracranial vertebral artery at any level without cross-clamping

Hemodynamic insufficiency resulting from extracranial vertebral artery stenosis or occlusion is believed to be the major cause of vertebrobasilar transient ischemic attacks. The major difficulties in treating this disorder have been exposure of the vertebral artery distal to the stenosis and the risk of vertebral artery cross-clamping for vein grafting or carotid artery transposition. The authors describe a new technique for vertebral artery reconstruction at any level by the use of an intraluminal shunt, thus avoiding the necessity to cross-clamp the artery. This procedure was successfully performed at all three levels of the extracranial vertebral artery: C7-4, C3-1, and C-1 to the foramen magnum. The technique of exposure of the vertebral artery at these three levels and the method of vein grafting without cross-clamping are described. The initial results of the procedure are presented.