Surgery of the proximal vertebral artery. Indications and results

Objectives : The purpose of this study was to: 1) detail the clinical prese ntations of diseases requiring revascularization of the vertebral artery an d recall the guidelines of the 1975 Ad Hoc committee; 2) identify the explo rations needed to detect vertebro-basilary insufficiency; 3) define operati ve indications since no consensus has been reached. Patients and methods : We reviewed retrospectively the files of 34 patients who underwent revascularization of the vertebral artery between January 19 90 and December 2000. Results : Surgery of the vertebral artery accounted for 4.6% of our vascula r surgery cases involving the brain. Fifty percent of the cases of vertebro -basilary insufficiency were caused by hemodynamic disorders and 26.5% by e mbolism; 23.5% of the patients had no neurological sign. The most frequent neurological signs were vertigo (44%), balance disorders (41%), long pathwa y involvement (32%). Vertebro-basilary reimplantation was performed in 76% of the cases. There were no cases of stroke and no deaths during the early postoperative period. There was one case of asymptomatic thrombosis. Mean f ollow-up was 33.6 months with no patients lost to follow-up. Overall surviv al was 85.29% at 3 years with patent arteries in 97.06% of the cases at 3 y ears. Conclusion : Our series is in agreement with others reported in the literat ure, emphasizing the good outcome achieved after vertebral artery surgery. Surgery helps improve signs of vertebro-basilary insufficiency with little operative risk. This surgery is rarely indicated but must be recognized. On e must also resist the temptation to "treat images".