Modified vertebral-carotid transposition treating stenosis at V1 segment of vertebral artery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GU Yuanrui ¹ , SUN Yangxue ¹ , QIN Yilang ¹ , TIAN Chen ¹ , REN Jingjing ² , TIAN Chuan ¹ , FANG Kun ¹ , OUYANG Wenbin ¹ , ZHANG Ying ¹ , LUO Mingyao ¹ , SHU Chang ¹ ,  OUYANG Chenxi ¹

1. Department of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P. R. China;
2. Party and Government Office, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P. R. China;

Corresponding author：

OUYANG Chenxi, Email: ouyangchx@nccd.org.cn

Keywords：

Vertebral-carotid transposition; vertebral artery occlusion; severe vertebral artery stenosis

DOI：

10.7507/1007-4848.202008054

Video：

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Objective To investigate the treatment of modified vertebral-carotid transposition (VCT) in patients with severe stenosis or occlusion at V1 segment of vertebral artery.Methods A retrospective study of 13 patients with severe stenosis or occlusion at V1 segment of vertebral artery treated by modified VCT in our hospital from October 2016 to December 2018 was done. There were 10 males and 3 females with an average age of 70.5±7.1 years.Results The operation was successful in this series of patients. The follow-up duration was 1-3 years. The stenosis degree of the V1 segment of the vertebral artery decreased from 86.8%±7.5% to 17.4%±14.5%. All patients achieved remission of symptoms after the surgery. Temporary peripheral nerve injury occurred in 6 patients. Four patients with neurological complications relieved during follow-up. The patency rate was 100.0% at postoperative 1 and 3 years. There was no perioperative death, stroke or re-intervention.Conclusion Modified VCT can precisely restore the distal blood flow of patients with severe stenosis or occlusion at V1 segment of vertebral artery, and relieve their symptoms.

Citation： GU Yuanrui, SUN Yangxue, QIN Yilang, TIAN Chen, REN Jingjing, TIAN Chuan, FANG Kun, OUYANG Wenbin, ZHANG Ying, LUO Mingyao, SHU Chang, OUYANG Chenxi. Modified vertebral-carotid transposition treating stenosis at V1 segment of vertebral artery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(3): 366-370. doi: 10.7507/1007-4848.202008054 Copy

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2.	Krishnamurthi RV, Feigin VL, Forouzanfar MH, et al. Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990-2010: Findings from the Global Burden of Disease Study 2010. Lancet Glob Health, 2013, 1(5): e259-e281.
3.	GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet, 2015, 385(9963): 117-171.
4.	Wang H, Dwyer-Lindgren L, Lofgren KT, et al. Age-specific and sex-specific mortality in 187 countries, 1970-2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012, 380(9859): 2071-2094.
5.	Liu M, Wu B, Wang WZ, et al. Stroke in China: Epidemiology, prevention, and management strategies. Lancet Neurol, 2007, 6(5): 456-464.
6.	中国医疗保健国际交流促进会血管疾病高血压分会专家共识写作组. 锁骨下/颅外椎动脉狭窄的处理: 中国专家共识. 中国循环杂志, 2019, 34(6): 523-532.
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8.	Marquardt L, Kuker W, Chandratheva A, et al. Incidence and prognosis of > or = 50% symptomatic vertebral or basilar artery stenosis: Prospective population-based study. Brain, 2009, 132(Pt 4): 982-988.
9.	Wityk RJ, Chang HM, Rosengart A, et al. Proximal extracranial vertebral artery disease in the New England Medical Center Posterior Circulation Registry. Arch Neurol, 1998, 55(4): 470-478.
10.	Li X, Guan L, Zilundu PLM, et al. The applied anatomy and clinical significance of the proximal, V1 segment of vertebral artery. Folia Morphol (Warsz), 2019, 78(4): 710-719.
11.	Berguer R, Flynn LM, Kline RA, et al. Surgical reconstruction of the extracranial vertebral artery: Management and outcome. J Vasc Surg, 2000, 31(1 Pt 1): 9-18.
12.	Berguer R. Suboccipital approach to the distal vertebral artery. J Vasc Surg, 1999, 30(2): 344-349.
13.	Aboyans V, Ricco J, Bartelink MEL, et al. 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries endorsed by: The European Stroke Organization (ESO) The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J, 2018, 39(9): 763-816.
14.	Compter A, van der Worp HB, Algra A, et al. Prevalence and prognosis of asymptomatic vertebral artery origin stenosis in patients with clinically manifest arterial disease. Stroke, 2011, 42(10): 2795-2800.
15.	Antoniou GA, Murray D, Georgiadis GS, et al. Percutaneous transluminal angioplasty and stenting in patients with proximal vertebral artery stenosis. J Vasc Surg, 2012, 55(4): 1167-1177.
16.	Parkhutik V, Lago A, Tembl JI, et al. Angioplasty and stenting of symptomatic and asymptomatic vertebral artery stenosis: To treat or not to treat. Eur J Neurol, 2010, 17(2): 267-272.
17.	Hass WK, Fields WS, North RR, et al. Joint study of extracranial arterial occlusion.Ⅱ. Arteriography, techniques, sites, and complications. JAMA, 1968, 203(11): 961-968.
18.	Che WQ, Dong H, Jiang XJ, et al. Clinical outcomes and influencing factors of in-stent restenosis after stenting for symptomatic stenosis of the vertebral V1 segment. J Vasc Surg, 2018, 68(5): 1406-1413.
19.	Motarjeme A, Keifer JW, Zuska AJ. Percutaneous transluminal angioplasty of the vertebral arteries. Radiology, 1981, 139(3): 715-717.
20.	Higashida RT, Tsai FY, Halbach VV, et al. Transluminal angioplasty for atherosclerotic disease of the vertebral and basilar arteries. J Neurosurg, 1993, 78(2): 192-198.
21.	Cloud GC, Crawley F, Clifton A, et al. Vertebral artery origin angioplasty and primary stenting: Safety and restenosis rates in a prospective series. J Neurol Neurosurg Psychiatry, 2003, 74(5): 586-590.
22.	Storey GS, Marks MP, Dake M, et al. Vertebral artery stenting following percutaneous transluminal angioplasty. Technical note. J Neurosurg, 1996, 84(5): 883-887.
23.	Stayman AN, Nogueira RG, Gupta R. A systematic review of stenting and angioplasty of symptomatic extracranial vertebral artery stenosis. Stroke, 2011, 42(8): 2212-2216.
24.	Roon AJ, Ehrenfeld WK, Cooke PB, et al. Vertebral artery reconstruction. Am J Surg, 1979, 138(1): 29-36.
25.	Kieffer E, Praquin B, Chiche L, et al. Distal vertebral artery reconstruction: Long-term outcome. J Vasc Surg, 2002, 36(3): 549-554.

1. Feigin VL, Forouzanfar MH, Krishnamurthi R, et al. Global and regional burden of stroke during 1990-2010: Findings from the Global Burden of Disease Study 2010. Lancet, 2014, 383(9913): 245-254.
2. Krishnamurthi RV, Feigin VL, Forouzanfar MH, et al. Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990-2010: Findings from the Global Burden of Disease Study 2010. Lancet Glob Health, 2013, 1(5): e259-e281.
3. GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet, 2015, 385(9963): 117-171.
4. Wang H, Dwyer-Lindgren L, Lofgren KT, et al. Age-specific and sex-specific mortality in 187 countries, 1970-2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012, 380(9859): 2071-2094.
5. Liu M, Wu B, Wang WZ, et al. Stroke in China: Epidemiology, prevention, and management strategies. Lancet Neurol, 2007, 6(5): 456-464.
6. 中国医疗保健国际交流促进会血管疾病高血压分会专家共识写作组. 锁骨下/颅外椎动脉狭窄的处理: 中国专家共识. 中国循环杂志, 2019, 34(6): 523-532.
7. Carrera E, Maeder-Ingvar M, Rossetti AO, et al. Trends in risk factors, patterns and causes in hospitalized strokes over 25 years: The Lausanne Stroke Registry. Cerebrovasc Dis, 2007, 24(1): 97-103.
8. Marquardt L, Kuker W, Chandratheva A, et al. Incidence and prognosis of > or = 50% symptomatic vertebral or basilar artery stenosis: Prospective population-based study. Brain, 2009, 132(Pt 4): 982-988.
9. Wityk RJ, Chang HM, Rosengart A, et al. Proximal extracranial vertebral artery disease in the New England Medical Center Posterior Circulation Registry. Arch Neurol, 1998, 55(4): 470-478.
10. Li X, Guan L, Zilundu PLM, et al. The applied anatomy and clinical significance of the proximal, V1 segment of vertebral artery. Folia Morphol (Warsz), 2019, 78(4): 710-719.
11. Berguer R, Flynn LM, Kline RA, et al. Surgical reconstruction of the extracranial vertebral artery: Management and outcome. J Vasc Surg, 2000, 31(1 Pt 1): 9-18.
12. Berguer R. Suboccipital approach to the distal vertebral artery. J Vasc Surg, 1999, 30(2): 344-349.
13. Aboyans V, Ricco J, Bartelink MEL, et al. 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries endorsed by: The European Stroke Organization (ESO) The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J, 2018, 39(9): 763-816.
14. Compter A, van der Worp HB, Algra A, et al. Prevalence and prognosis of asymptomatic vertebral artery origin stenosis in patients with clinically manifest arterial disease. Stroke, 2011, 42(10): 2795-2800.
15. Antoniou GA, Murray D, Georgiadis GS, et al. Percutaneous transluminal angioplasty and stenting in patients with proximal vertebral artery stenosis. J Vasc Surg, 2012, 55(4): 1167-1177.
16. Parkhutik V, Lago A, Tembl JI, et al. Angioplasty and stenting of symptomatic and asymptomatic vertebral artery stenosis: To treat or not to treat. Eur J Neurol, 2010, 17(2): 267-272.
17. Hass WK, Fields WS, North RR, et al. Joint study of extracranial arterial occlusion.Ⅱ. Arteriography, techniques, sites, and complications. JAMA, 1968, 203(11): 961-968.
18. Che WQ, Dong H, Jiang XJ, et al. Clinical outcomes and influencing factors of in-stent restenosis after stenting for symptomatic stenosis of the vertebral V1 segment. J Vasc Surg, 2018, 68(5): 1406-1413.
19. Motarjeme A, Keifer JW, Zuska AJ. Percutaneous transluminal angioplasty of the vertebral arteries. Radiology, 1981, 139(3): 715-717.
20. Higashida RT, Tsai FY, Halbach VV, et al. Transluminal angioplasty for atherosclerotic disease of the vertebral and basilar arteries. J Neurosurg, 1993, 78(2): 192-198.
21. Cloud GC, Crawley F, Clifton A, et al. Vertebral artery origin angioplasty and primary stenting: Safety and restenosis rates in a prospective series. J Neurol Neurosurg Psychiatry, 2003, 74(5): 586-590.
22. Storey GS, Marks MP, Dake M, et al. Vertebral artery stenting following percutaneous transluminal angioplasty. Technical note. J Neurosurg, 1996, 84(5): 883-887.
23. Stayman AN, Nogueira RG, Gupta R. A systematic review of stenting and angioplasty of symptomatic extracranial vertebral artery stenosis. Stroke, 2011, 42(8): 2212-2216.
24. Roon AJ, Ehrenfeld WK, Cooke PB, et al. Vertebral artery reconstruction. Am J Surg, 1979, 138(1): 29-36.
25. Kieffer E, Praquin B, Chiche L, et al. Distal vertebral artery reconstruction: Long-term outcome. J Vasc Surg, 2002, 36(3): 549-554.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Modified vertebral-carotid transposition treating stenosis at V1 segment of vertebral artery

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