Proximal vertebral artery surgery. Results of treatment of ischemia of the rhombencephalon (hindbrain). Simultaneous carotid and vertebral artery decompression procedures.

Abstract

Surgical treatment of hindbrain ischemia is becoming the accepted surgical procedure in cases of stenosis of extracranial segments of vertebral arteries in the course of advanced atherosclerotic lesions in their initial segments (V1) or caused by external compression of these arteries in the canal formed by the transverse processes of cervical vertebrae. The latter is referred to as vertebrobasilar insufficiency (VBI). The transposition of the left vertebral artery to the common carotid artery in cases where stent graft implantation is necessary with coverage of the subclavian artery and possible blood supply disorders of both the hindbrain and the spinal cord has become important. In the Department of Vascular Surgery at the Medical University in Wrocław , in 58 out of 76 patients treated for ischemia of the hindbrain, the procedures were performed in the distal vertebral artery. The authors present the diagnosis of 18 patients treated surgically for stenosis or kinking of vertebral arteries in their first segment. In 12 cases, the procedure was performed with simultaneous unblocking of significantly narrowed left internal carotid artery. The material includes patients operated on between 1994 and 2018, most of whom had a good or very good outcome with zero mortality.