Abstract
Three patients with proximal vertebral artery occlusive disease were treated by extracranial surgical reconstruction. Two patients (Cases 1 and 2) had symptoms of vertebrobasilar insufficiency and one (Case 3) had severe headache. Angiography demonstrated bilateral vertebral stenosis in Case 1, right stenosis and left occlusion in Case 2, and right hypoplasia and left stenosis in Case 3. In Case 2, the left vertebral artery was occluded at its origin and was reconstituted via the thyreocervical trunk at the C3 level. Right carotid angiography during left carotid artery compression failed to demonstrate blood flow through the left carotid artery in Cases 1 and 3. The posterior communicating arteries were hypoplastic or absent bilaterally and right vertebral angiography did not demonstrate blood flow in the left vertebral artery in Case 3. Three types of surgical procedures were undertaken: left proximal vertebral artery to common carotid artery end-to-side anastomosis in Case 1; left external carotid artery to midcervical vertebral artery end-to-side anastomosis in Case 2; and transposition of the left vertebral artery to the distal subclavian artery with end-to-side anastomosis in Case 3. The authors successfully performed surgical reconstruction of the proximal vertebral artery by means of internal carotid artery shunting in Case 1 and external shunting between the carotid and vertebral arteries in Case 3, to avoid the danger of carotid and vertebral artery cross-clamping during the anastomoses.
