Vertebral arterial reconstruction: a nineteen-year experience.

Between January 1964 and December 1983, 109 operations were performed directly on the vertebral arteries whereas a total of 1727 carotid operations were done, resulting in an incidence of vertebral operations of 5.6%. Unilateral vertebral operations only were performed in the treatment of bilateral flow-restricting lesions with cerebral hemispheric or brain stem symptoms present or persisting despite widely patent carotid arteries or in the presence of inoperable totally occluded internal carotid vessels. The average follow-up period (9.9 years; the longest was 19 years) revealed an overall survival rate of 71% with a stroke rate of 1.5% per average year of follow-up. Specific operative procedures performed were subclavian-vertebral roof-patch angioplasty with plication of associated vertebral kinks in 102 patients, reimplantation of the end of the proximal vertebral artery into the side of the ipsilateral carotid artery in four patients, carotid-vertebral vein bypass in two patients, and decompression of herniated vertebral arteries between segments of foramina transversaria by unroofing the bony canal. The overall operative mortality rate was 3%. The most common neurologic complications were transient phrenic nerve paralysis and usually mild Horner's syndrome.