Surgical treatment of vertebral artery stenosis: a clinical analysis of 6 cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YANG Genhuan , WANG Yan , LIAO Pengzhi ,  JIA Yulong

Department of Vascular Surgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100070, P. R. China;

Corresponding author：

JIA Yulong, Email: drjia@sina.com

Keywords：

vertebral artery stenosis; vertebral artery occlusion; open surgery; revascularization

DOI：

10.7507/1007-9424.201912001

Video：

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Objective To evaluate the effect of surgical treatment of vertebral artery stenosis and to summarize the experience.Method The clinical data of 6 patients undergoing surgical treatment from September 2018 to September 2019 were retrospectively analyzed.Results All the procedures were successfully performed without intraoperative cerebral infarction, injury of thoracic duct or nerve disconnection by mistake. The operative time was 120 to 270 minutes, the median was 180 minutes. The blood loss was 50 to 150 milliliters, and the median was 65 milliliters. One patient suffered from Horner’s syndrome after the operation. One patient suffered from cerebral infarction on 4 days after the operation. During the follow-up of 3–10 months, three patients felt dizziness relieved and there were no anastomotic stricture or new cerebral infarction happened.Conclusions Surgical treatment is safeand effective for vertebral artery stenosis. Revascularization of the carotid and vertebral arteries at the same time shouldbe avoided.

Citation： YANG Genhuan, WANG Yan, LIAO Pengzhi, JIA Yulong. Surgical treatment of vertebral artery stenosis: a clinical analysis of 6 cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(9): 1117-1120. doi: 10.7507/1007-9424.201912001 Copy

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2.	Maciejewski DR, Pieniazek P, Tekieli L, et al. Comparison of drug-eluting and bare metal stents for extracranial vertebral artery stenting. Postepy Kardiol Interwencyjnej, 2019, 15(3): 328-337.
3.	Coward LJ, Featherstone RL, Brown MM. Percutaneous transluminal angioplasty and stenting for vertebral artery stenosis. Cochrane Database Syst Rev, 2005, 18(2): CD000516.
4.	Markus HS, Larsson SC, Dennis J, et al. Vertebral artery stenting to prevent recurrent stroke in symptomatic vertebral artery stenosis: the VIST RCT. Health Technol Assess, 2019, 23(41): 1-30.
5.	Gulli G, Marquardt L, Rothwell PM, et al. Stroke risk after posterior circulation stroke/transient ischemic attack and its relationship to site of vertebrobasilar stenosis: pooled data analysis from prospective studies. Stroke, 2013, 44(3): 598-604.
6.	Chen Z, Zhang S, Dai Z, et al. Recurrent risk of ischemic stroke due to Vertebrobasilar Dolichoectasia. BMC Neurol, 2019, 19(1): 163.
7.	Langwieser N, Buyer D, Schuster T, et al. Bare metal vs. drug-eluting stents for extracranial vertebral artery disease: a meta-analysis of nonrandomized comparative studies. J Endovasc Ther, 2014, 21(5): 683-692.
8.	Markus HS, Harshfield EL, Compter A, et al. Stenting for symptomatic vertebral artery stenosis: a preplanned pooled individual patient data analysis. Lancet Neurol, 2019, 18(7): 666-673.
9.	Cambria RP. 2017 European Society for Vascular Surgery guidelines for management of carotid and vertebral artery disease. J Vasc Surg, 2018, 67(2): 361-362.
10.	Jenkins JS, White CJ, Ramee SR, et al. Vertebral insufficiency: when to intervene and how? Curr Interv Cardiol Rep, 2000, 2(2): 91-94.
11.	He Y, Li T, Bai W, et al. Cerebrovascular drug-eluting stent versus bare-metal stent in the treatment of vertebral artery stenosis: a non-inferiority randomized clinical trial. J Stroke, 2019, 21(1): 101-104.
12.	Jenkins JS, Stewart M. Endovascular treatment of vertebral artery stenosis. Prog Cardiovasc Dis, 2017, 59(6): 619-625.
13.	Khasanov IA, Bogdanov EI. Significance of focal and nonfocal symptoms in the diagnostics of transient vertebrobasilar ischemic syndromes. Zh Nevrol Psikhiatr Im S S Korsakova, 2019, 119(5): 15-21.
14.	Tanaka K, Steinfort B. Rare cause of Bow Hunter’s syndrome due to an aberrant course of a vertebral artery. BMJ Case Rep, 2019, 12(7): e229584.
15.	Kan P, Srivatsan A, Johnnson JN, et al. Rotational carotid insufficiency: an unusual cause of bow hunter’s syndrome. BMJ Case Rep, 2018, 2018: e014210.
16.	Kline RA, Berguer R. Vertebral artery reconstruction. Ann Vasc Surg, 1993, 7(5): 497-501.
17.	Vachev AN, Dmitriev OV, Stepanov MI. Comparative analysis of results of revascularization of the first segment of vertebral arteries. Angiol Sosud Khir, 2019, 25(2): 103-109.
18.	Vachev AN, Dmitriev OV. The operative technique of shunting to the third (V3) segment of the vertebral artery. Angiol Sosud Khir, 2017, 23(3): 98-110.
19.	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.
20.	Berguer R, Morasch MD, Kline RA. A review of 100 consecutive reconstructions of the distal vertebral artery for embolic and hemodynamic disease. J Vasc Surg, 1998, 27(5): 852-859.
21.	Berguer R. Suboccipital approach to the distal vertebral artery. J Vasc Surg, 1999, 30(2): 344-349.
22.	Habozit B. Vertebral artery reconstruction: results in 106 patients. Ann Vasc Surg, 1991, 5(1): 61-65.
23.	Branchereau A, Magnan PE. Results of vertebral artery reconstruction. J Cardiovasc Surg (Torino), 1990, 31(3): 320-326.
24.	Edwards WH Sr. Vertebral artery reconstruction: indications and techniques. Semin Vasc Surg, 1996, 9(2): 105-110.
25.	Usachev DY, Lukshin VA, Shevchenko EV, et al. Simultaneous reconstruction of the carotid and vertebral arteries using a temporary intraluminal shunt (a clinical case). Zh Vopr Neirokhir Im N N Burdenko, 2017, 81(5): 76-83.

1. Savitz SI, Caplan LR. Vertebrobasilar disease. N Engl J Med, 2005, 352(25): 2618-2626.
2. Maciejewski DR, Pieniazek P, Tekieli L, et al. Comparison of drug-eluting and bare metal stents for extracranial vertebral artery stenting. Postepy Kardiol Interwencyjnej, 2019, 15(3): 328-337.
3. Coward LJ, Featherstone RL, Brown MM. Percutaneous transluminal angioplasty and stenting for vertebral artery stenosis. Cochrane Database Syst Rev, 2005, 18(2): CD000516.
4. Markus HS, Larsson SC, Dennis J, et al. Vertebral artery stenting to prevent recurrent stroke in symptomatic vertebral artery stenosis: the VIST RCT. Health Technol Assess, 2019, 23(41): 1-30.
5. Gulli G, Marquardt L, Rothwell PM, et al. Stroke risk after posterior circulation stroke/transient ischemic attack and its relationship to site of vertebrobasilar stenosis: pooled data analysis from prospective studies. Stroke, 2013, 44(3): 598-604.
6. Chen Z, Zhang S, Dai Z, et al. Recurrent risk of ischemic stroke due to Vertebrobasilar Dolichoectasia. BMC Neurol, 2019, 19(1): 163.
7. Langwieser N, Buyer D, Schuster T, et al. Bare metal vs. drug-eluting stents for extracranial vertebral artery disease: a meta-analysis of nonrandomized comparative studies. J Endovasc Ther, 2014, 21(5): 683-692.
8. Markus HS, Harshfield EL, Compter A, et al. Stenting for symptomatic vertebral artery stenosis: a preplanned pooled individual patient data analysis. Lancet Neurol, 2019, 18(7): 666-673.
9. Cambria RP. 2017 European Society for Vascular Surgery guidelines for management of carotid and vertebral artery disease. J Vasc Surg, 2018, 67(2): 361-362.
10. Jenkins JS, White CJ, Ramee SR, et al. Vertebral insufficiency: when to intervene and how? Curr Interv Cardiol Rep, 2000, 2(2): 91-94.
11. He Y, Li T, Bai W, et al. Cerebrovascular drug-eluting stent versus bare-metal stent in the treatment of vertebral artery stenosis: a non-inferiority randomized clinical trial. J Stroke, 2019, 21(1): 101-104.
12. Jenkins JS, Stewart M. Endovascular treatment of vertebral artery stenosis. Prog Cardiovasc Dis, 2017, 59(6): 619-625.
13. Khasanov IA, Bogdanov EI. Significance of focal and nonfocal symptoms in the diagnostics of transient vertebrobasilar ischemic syndromes. Zh Nevrol Psikhiatr Im S S Korsakova, 2019, 119(5): 15-21.
14. Tanaka K, Steinfort B. Rare cause of Bow Hunter’s syndrome due to an aberrant course of a vertebral artery. BMJ Case Rep, 2019, 12(7): e229584.
15. Kan P, Srivatsan A, Johnnson JN, et al. Rotational carotid insufficiency: an unusual cause of bow hunter’s syndrome. BMJ Case Rep, 2018, 2018: e014210.
16. Kline RA, Berguer R. Vertebral artery reconstruction. Ann Vasc Surg, 1993, 7(5): 497-501.
17. Vachev AN, Dmitriev OV, Stepanov MI. Comparative analysis of results of revascularization of the first segment of vertebral arteries. Angiol Sosud Khir, 2019, 25(2): 103-109.
18. Vachev AN, Dmitriev OV. The operative technique of shunting to the third (V3) segment of the vertebral artery. Angiol Sosud Khir, 2017, 23(3): 98-110.
19. 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.
20. Berguer R, Morasch MD, Kline RA. A review of 100 consecutive reconstructions of the distal vertebral artery for embolic and hemodynamic disease. J Vasc Surg, 1998, 27(5): 852-859.
21. Berguer R. Suboccipital approach to the distal vertebral artery. J Vasc Surg, 1999, 30(2): 344-349.
22. Habozit B. Vertebral artery reconstruction: results in 106 patients. Ann Vasc Surg, 1991, 5(1): 61-65.
23. Branchereau A, Magnan PE. Results of vertebral artery reconstruction. J Cardiovasc Surg (Torino), 1990, 31(3): 320-326.
24. Edwards WH Sr. Vertebral artery reconstruction: indications and techniques. Semin Vasc Surg, 1996, 9(2): 105-110.
25. Usachev DY, Lukshin VA, Shevchenko EV, et al. Simultaneous reconstruction of the carotid and vertebral arteries using a temporary intraluminal shunt (a clinical case). Zh Vopr Neirokhir Im N N Burdenko, 2017, 81(5): 76-83.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Surgical treatment of vertebral artery stenosis: a clinical analysis of 6 cases

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