Surgical Treatment of Vertebral Artery Stenosis: An Overlooked Surgery with Low Morbidity

Abstract

Introduction: Vertebral artery stenosis (VAS) as a cause of ischemic events and its surgical treatment is an overlooked subject. After reporting our initial results [1], the outcome results of VAS operations and the follow-up are analyzed. Methods: Forty three patients were operated for VAS. Most common symptoms were vertigo and loss of balance in 38 (88.4%) and 14 (32.6%) patients, respectively. Dyslipidemia was present in 39 (90.7%) patients. Twenty five were male (58.1%) and the average age was 64.6±9.8 (50-90) years. During surgical operation, vertebral artery exploration was commenced from as distal as possible after transecting the scalene anterior muscle in order to avoid damage to the sympathetic ganglia. The procedures were as follows: VA transposition in 30 (69.8%), VA bypass 8 (18.6%), saphenous vein interposition in VA in 4 (9.3%) and decompression of kinking in 1 (2.3%) patients. Twenty seven procedures (62.8%) were performed on the left and 16 (37.2%) on the right side. Ipsilateral carotid disease was present in 25 (58.1%) cases and 11 of them had concomitant carotid surgery. Of these, 9 had bilateral disease. Results: One (2.3%) mortality occurred. Ten patients (23.3%) had morbidities which were related to the intervention. Horner syndrome occurred in 5 (11.6%) patients. Average durations of intensive care and hospital stays were 1.7±2.1 (1-11) and 6.0±6.7 (3-32) days, respectively. Average duration of follow-up was 22.3±22.0 (0.1-71.6) months (total 79.8 patient/years). Two patients (4.7%) had cerebrovascular events (CVE) occurred during the follow-up (one in the 48th day and the other after 2.3 years later). CVE-free survival was 1.8±1.8 years in average. Five patients (11.6%) had short-termed symptoms during follow-up. Thirty seven patients (86.0%) had CT angiography during follow-up. The CT angiography follow-up duration in average was 17.1±20.6 (0.1-69.8) months with a total of 52.7 years. Two patients (5.4%) had restenosis. Restenosis-free survival was 15.5±20.4 (0.1-69.8) months (total 49.0 patient/years) (Figure 1). One-year patency of VA after procedure was 89.1%±7.4%. One and three years CVE-free survivals were 97.1%±2.9% and 90.1%±7.2%, respectively (Figure 2). Overall survival of the patients at 2 and 5 years were 91.4%±5.8% and 83.8%±9.0%, respectively (Figure 3). Conclusion: Vertebral artery surgery can be performed with acceptable mortality and morbidity rates. Minor modifications in surgical exposure will avoid Horner's syndrome and many other surgical complications. Restenosis-free, CVE-free and overall survival rates are satisfactory. Disclosure: None to disclose