Objectives: The purpose of this study was to: 1) detail the clinical presentations of diseases requiring revascularization of the vertebral artery and recall the guidelines of the 1975 Ad Hoc committee; 2) identify the explorations needed to detect vertebro-basilary insufficiency; 3) define operative indications since no consensus has been reached.
Patients and methods: We reviewed retrospectively the files of 34 patients who underwent revascularization of the vertebral artery between January 1990 and December 2000.
Results: Surgery of the vertebral artery accounted for 4.6% of our vascular surgery cases involving the brain. Fifty percent of the cases of vertebro-basilary insufficiency were caused by hemodynamic disorders and 26.5% by embolism; 23.5% of the patients had no neurological sign. The most frequent neurological signs were vertigo (44%), balance disorders (41%), long pathway involvement (32%). Vertebro-basilary reimplantation was performed in 76% of the cases. There were no cases of stroke and no deaths during the early postoperative period. There was one case of asymptomatic thrombosis. Mean follow-up was 33.6 months with no patients lost to follow-up. Overall survival was 85.29% at 3 years with patent arteries in 97.06% of the cases at 3 years.
Conclusion: Our series is in agreement with others reported in the literature, emphasizing the good outcome achieved after vertebral artery surgery. Surgery helps improve signs of vertebro-basilary insufficiency with little operative risk. This surgery is rarely indicated but must be recognized. One must also resist the temptation to "treat images".