Carotid-Vertebral By-Pass in Occlusion of a Vertebral Artery

S. Gladishev*, G. Antonov**, G. Dobrovolskiy***, V. Lazarev*, G. Mitroshin**, E. Miklashevich**

* Faculty of Neurosurgery, Russian Medical Academy of Postgraduate Education, Moscow, Russia
** Vishnevsky Central Military Clinical Hospital N3, Krasnogorsk, Russia
*** Burdenko Research Institute of Neurosurgery, Moscow, Russia

 

The study goal has been determination of indications for distal reconstruction of a vertebral artery (VA) in cases with vertebrobasilar insufficiency (VBI), using an occipital artery (OA).

Material and Methods. There were 19 cases, aged 20-70 (mean age – 49.5 years), who were operated in 1996-2009. The results of their treatment were analyzed. The majority of them had atherosclerotic occlusion of V1 segment of VA. Operations, performed in these cases, were as follows: occipital-vertebral anastomosis (OVA) in the area between C1 and C2 vertebrae (10); subcranial desympathization of VA at the level of V3 segment (5) due to impossibility of applying anastomosis (3) and VA compression, caused by Kimmerle’s anomaly and a bullet (2); common carotid-vertebral autovenous by-pass in traumatic lesion of V2 segment (2); internal carotid- vertebral anastomosis in ICA occlusion (1); VA ligation at the level of V1 and V3 in false aneurysm (1).

Results. Decrease of VBI manifestations was watched in all the cases. Estimation was carried out on the basis of Rankin scale. Preoperative scores were as follows: 4 – 3 cases (15.7%) with acute stroke and sequelae of an acute disorder of cerebral circulation in a vertebrobasilar region; 3 – 3 cases (15.7%); 2 – 11 cases (57.9%); 1 – 2 cases (10.5%). Postoperative evaluation revealed the following scores: 3 – 2 cases (10.5%); 2 – 1 case (5.25%); 1 – 9 cases (47.35%) and 0 – 7 cases (36.85%). There were no complications and fatal outcomes.

Conclusion. Occipital-vertebral anastomosis can be a version of treatment of chronic VBI. This type of distal reconstruction is more preferable, when a ratio of VA/OA diameters is not more than 1.5/1. In case of functioning retromastoid anastomosis, common-carotid-vertebral autovenous by-pass is more expedient.