Clinical and angiographic long-term outcomes of vertebral artery-subclavian artery transposition to treat symptomatic stenosis of vertebral artery origin.
OBJECTIVE
Although angioplasty and stent placement for vertebral artery (VA)-origin stenosis have been performed using endovascular techniques, a high likelihood of restenosis has been observed in the long term. Therefore, the authors assessed the long-term clinical and angiographic outcomes in patients after VA-subclavian artery (SA) transposition.


METHODS
Thirty-six patients (31 men, 5 women; mean age 64.3 years, range 46-76 years) underwent clinical evaluation (modified Rankin Scale [mRS]) and cervical angiographic evaluation preoperatively and within 1 month of and 6 months after VA-SA transposition undertaken to treat symptomatic stenosis of VA origin.


RESULTS
Postoperative neurological deficits due to intraoperative brain ischemia did not occur, and MR imaging demonstrated no new postoperative ischemic lesions in any of the patients. One patient died of acute myocardial infarction 2 months after surgery and another developed a left thalamic hemorrhage (mRS score of 5) at 42 months postsurgery. None of the remaining 34 patients experienced further ischemic events, and the mRS score in all of these patients remained unchanged during a mean follow-up period of 54 months. The degree of VA-origin stenosis (preoperative mean 84%) was reduced to < or = 30% after surgery (mean 2%). Long-term follow-up angiography in 29 patients (81%) revealed the absence of restenosis, defined as > 50% luminal narrowing, in all of them.


CONCLUSIONS
The clinical and angiographic long-term outcomes demonstrated here suggest that VA-SA transposition will be useful in patients with symptomatic stenosis of VA origin.
Kakino
Shunsuke
S
Departments of Neurosurgery, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate 020-8505, Japan. skakino@iwate-med.ac.jp
Ogasawara
Kuniaki
K
Kubo
Yoshitaka
Y
Kashimura
Hiroshi
H
Konno
Hiromu
H
Sugawara
Atsushi
A
Kobayashi
Masakazu
M
Sasaki
Makoto
M
Ogawa
Akira
A
D000368:Aged; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013348:Subclavian Artery / Q000601:surgery*; D016896:Treatment Outcome; D014711:Vertebral Artery / Q000601:surgery*; D014715:Vertebrobasilar Insufficiency / Q000601:surgery*