Abstract
The usefulness of the percutaneous transluminal angioplasty (PTA) and necessity of the surgical reconstructions for the atheromatous vertebral artery (VA) stenosis at the origin and mechanical VA stenosis at the first segment are discussed.
Between March 1984 and November 1992, 82 atheromatous VA stenoses at the origin were surgically reconstructed. After surgery, minor complications such as miosis (44 cases), Horner's syndrome (1 case), hoarseness (2 cases) and postoperative local bleeding requiring reoperation (2 cases) occurred. However, no additional cerebral ischemic sign was observed, and all anastomoses were patent. Between December 1992 and August 1994, 35 atheromatous VA stenoses at the origin were reconstructed. PTA was applied for 30 lesions and 27 were successful. Among them, 4 showed restenosis and one showed occlusion. Small thalamic infarction occurred 3 hours after uneventful PTA in 1 case. Ten surgical reconstructions were performed in cases of unabled PTA (3), with restenosis (2), with widespread stenosis (3), with mechanical compression (1) and with embolus distal to the VA stenosis (1)
For 45 mechanical VA stenoses at the first segment, surgical reconstructions were performed in all cases, because PTA was ineffective.
For reconstruction of the atheromatous VA stenosis, PTA seemed to be a simple, non-invasive, and effective method. But we should watch for restenosis after PTA and embolism during and after PTA. In these cases, PTA seems to be dangerous and surgery is the treatment of choice. We should be familiar with not only PTA but also surgery to get the best results and to avoid surgical complications.
