Techniques for Reconstruction of the Vertebral Artery

Abstract

The lesion most commonly affecting the vertebral artery (VA) is a plaque stenosing its takeoff from the subclavian artery. This lesion alone is responsible for approximately 70% of all VA reconstructions. In its intraspinal course the VA is affected by atherosclerosis and by other entities; however, from C₂ up to the atlanto-occipital membrane, where the artery becomes intradural, the artery is usually spared from disease. The correction of compression or occlusion of the VA in its intraspinal course is done by accessing the distal vertebral artery at the C₂-C₁ intervertebral space. This segment of the artery, as mentioned above, is seldom involved by disease and is the widest gap between any of the transverse processes. This permits the surgeon to work in the distal VA with relative ease. Very rarely, usually in the course of repairing an aneurysm, will the VA have to be dissected above the transverse process of C₁ in its horizontal portion below the occipital bone.