Long-term results of direct vertebral artery operations

Arteriosclerotic occlusive disease of the vertebral arteries is common; however, vertebral artery operations are performed infrequently. From 1971 through 1983 more than 3000 cerebrovascular operations were performed; only 40 of these were direct vertebral artery operations. There were 22 women and 18 men, varying in age from 44 to 80 years (mean 61.6 years). Symptoms included dizziness or vertigo in 29 patients (73%), transient ischemic attacks in 17 (43%), syncope in eight (20%), and previous stroke in 14 (35%). Operative procedures were directed toward establishing normal antegrade vertebral flow by reimplantation (21 patients), patch graft (15 patients), or grafts (three patients). Two patients underwent bilateral procedures. There were no operative deaths. All except two patients (95%) were available for follow-up at 1 to 12 years (mean follow-up 7.75 years). There were eight late deaths from 1 to 9 years, with a 12-year actuarial survival rate of 75.8%. The eight patients who died were known to be without symptoms before death. Of the 30 survivors available for follow-up, 21 remained without symptoms, seven patients showed no improvement, two patients who had no symptoms had recurrence at 4 and 5 years, and one patient without symptoms had a stroke at 7 years. In this select group of patients with severe disease, direct vertebral artery operations have resulted in significant long-term relief of symptoms and prevention of transient ischemic attacks and strokes.