1 From the Department of Surgery, State University of New York, Downstate Medical Center, Brooklyn, New York; and the Departments of Surgery and Medicine and the Cardiovascular Research Laboratory, Mercy Hospital, Rockville Centre, New York 11570.
Vertebral arterial insufficiency syndromes are being diagnosed with greater frequency, and would appear to be at least as common as carotid disease in causing cerebrovascular insufficiency. Carotid lesions are nearly always arteriosclerotic, but vertebral obstructions are caused at least as frequently by nonarteriosclerotic lesions, including tortuosity with kink and external bands, slings, bony compression, and congenital aberrations. A method of cerebral arteriography has been standardized and a new radiographic sign of comparative opacification times of the intracranial carotid and basilar arteries has been tested as a pathognomonic sign of vertebral-basilar arterial insufficiency. The concept of the innominate-subclavian-vertebral complex as a single surgical geometric unit has allowed the development of a graded surgical approach of arteriolysis, endarterectomy, and resection and anastomosis in managing 97% of obstructive vertebral arteriopathies. A new surgical operation of distal subclavian resection and anastomosis to correct vertebral and/or subclavian arterial tortuosity with kinking has proven helpful in ablating symptoms of vertebral-basilar arterial insufficiency.
© 1973 American Heart Association, Inc.
New Arteriographic and Surgical Techniques for Vertebral Arteriopathies
Key Words: Cerebrovascular arterial insufficiency • Arterial tortuosity and kinking • Distal subclavian resection and anastomosis • Arteriosclerosis • Stroke prevention • Cerebral arterial reconstruction • Arteriolysis • Endarterectomy