Vertebral Artery Reconstruction

  • Mark D. Morasch


While the need for vertebral artery reconstruction is uncommon, indications for surgical or endovascular intervention should be recognized. Open surgical reconstruction is favored. Technical aspects of the most common surgical proximal and distal reconstruction options as well as techniques for endovascular intervention are described.


Vertebral Ischemia Posterior circulation Vertebrobasilar ischemia Atherosclerosis 


  1. 1.
    Morasch MD, Phade SV, Hurie JH, Naughton PA, Garcia-Toca M, Escobar G, Berguer R. Primary extracranial vertebral artery aneurysms. Ann Vasc Surg. 2013;27(4):418–23.CrossRefGoogle Scholar
  2. 2.
    Sultan S, Morasch M, Colgan MP, Madhavan P, Moore D, Shanik G. Operative and endovascular management of extracranial vertebral artery aneurysm in Ehlers-Danlos syndrome: a clinical dilemma, case report and literature review. Vasc Endovasc Surg. 2002;36:389–92.CrossRefGoogle Scholar
  3. 3.
    Wityk RJ, Chang HM, Rosengart A, et al. Proximal extracranial vertebral artery disease in the New England Medical Center Posterior Circulation Registry. Arch Neurol. 1998;55(4):470–8.CrossRefGoogle Scholar
  4. 4.
    Cartlidge NE, Whisnant JP, Elveback LR. Carotid and vertebral-basilar transient cerebral ischemic attacks. A community study, Rochester, Minnesota. Mayo Clin Proc. 1977;52(2):117–20.PubMedGoogle Scholar
  5. 5.
    Heyman A, Wilkinson WE, Hurwitz BJ, et al. Clinical and epidemiologic aspects of vertebrobasilar and nonfocal cerebral ischemia. In: Berguer R, Bauer RB, editors. Vertebrobasilar arterial occlusive disease. Medical and surgical management. New York: Raven Press; 1984. p. 27–36.Google Scholar
  6. 6.
    Whisnant JP, Cartlidge NE, Elveback LR. Carotid and vertebral-basilar transient ischemic attacks: effect of anticoagulants, hypertension, and cardiac disorders on survival and stroke occurrence—a population study. Ann Neurol. 1978;3(2):107–15.CrossRefGoogle Scholar
  7. 7.
    Jones HR Jr, Millikan CH, Sandok BA. Temporal profile (clinical course) of acute vertebrobasilar system cerebral infarction. Stroke. 1980;11(2):173–7.CrossRefGoogle Scholar
  8. 8.
    McDowell FH, Potes J, Groch S. The natural history of internal carotid and vertebral-basilar artery occlusion. Neurology. 1961;11(4 Pt2):153–7.PubMedGoogle Scholar
  9. 9.
    Patrick BK, Ramirez-Lassepas M, Synder BD. Temporal profile of vertebrobasilar territory infarction. Prognostic implications. Stroke. 1980;11(6):643–8.CrossRefGoogle Scholar
  10. 10.
    Caplan LR, Wityk RJ, Glass TA, et al. New England Medical Center posterior circulation registry. Ann Neurol. 2004;56(3):389–98.CrossRefGoogle Scholar
  11. 11.
    Berguer R, Higgins R, Nelson R. Noninvasive diagnosis of reversal of vertebral-artery blood flow. N Engl J Med. 1980;302(24):1349–51.CrossRefGoogle Scholar
  12. 12.
    Berguer R. Distal vertebral artery bypass: technique, the “occipital connection,” and potential uses. J Vasc Surg. 1985;2(4):621–6.PubMedGoogle Scholar
  13. 13.
    Edwards WH, Mulherin JL Jr. The surgical approach to significant stenosis of vertebral and subclavian arteries. Surgery. 1980;87(1):20–8.PubMedGoogle Scholar
  14. 14.
    Berguer R. Complex carotid and vertebral revascularizations. In: Pearce WH, Matsumura JS, Yao JST, editors. Vascular surgery in the endovascular era. Evanston: Greenwood Academic; 2008. p. 344–52.Google Scholar
  15. 15.
    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):852–9.CrossRefGoogle Scholar
  16. 16.
    Berguer R, Flynn LM, Kline RA, Caplan L. Surgical reconstruction of the extracranial vertebral artery: management and outcome. J Vasc Surg. 2000;31(1 Pt 1):9–18.CrossRefGoogle Scholar
  17. 17.
    Jenkins JS, Patel SN, White CJ, et al. Endovascular stenting for vertebral artery stenosis. J Am Coll Cardiol. 2010;55(6):538–42.CrossRefGoogle Scholar
  18. 18.
    Coward LJ, Featherstone RL, Brown MM. Percutaneous transluminal angioplasty and stenting for vertebral artery stenosis. Cochrane Database Syst Rev. 2005;2:CD000516.Google Scholar
  19. 19.
    SSYLVIA Study Investigators. Stenting of symptomatic atherosclerotic lesions in the vertebral or intracranial arteries (SSYLVIA): study results. Stroke. 2004;35(6):1388–92.CrossRefGoogle Scholar
  20. 20.
    Stone GW, Ellis SG, Cox DA, et al. A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease. N Engl J Med. 2004;350(3):221–31.CrossRefGoogle Scholar
  21. 21.
    Ogilvy CS, Yang X, Natarajan SK, et al. Restenosis rates following vertebral artery origin stenting: does stent type make a difference? J Invasive Cardiol. 2010;22(3):119–24.PubMedGoogle Scholar
  22. 22.
    Steinfort B, Ng PP, Faulder K, et al. Midterm outcomes of paclitaxel-eluting stents for the treatment of intracranial posterior circulation stenoses. J Neurosurg. 2007;106(2):222–5.CrossRefGoogle Scholar
  23. 23.
    Vajda Z, Miloslavski E, Guthe T, et al. Treatment of stenoses of vertebral artery origin using short drug-eluting coronary stents: improved follow-up results. AJNR Am J Neuroradiol. 2009;30(9):1653–6.CrossRefGoogle Scholar
  24. 24.
    Compter A, van der Worp HB, Schonewille WJ, et al. VAST: vertebral artery stenting trial. Protocol for a randomised safety and feasibility trial. Trials. 2008;9:65.CrossRefGoogle Scholar

Copyright information

© The Author(s) 2018

Authors and Affiliations

  • Mark D. Morasch
    • 1
  1. 1.Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic and Vascular SurgeryBillings ClinicBillingsUSA

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