Radial Artery Bypass for Intractable Vertebrobasilar Insufficiency: Case Series and Review of the Literature.
BACKGROUND
Vertebrobasilar insufficiency resulting from embolism, atherosclerosis, or arterial dissection has long been a challenge for successful management and outcomes. The main treatment options include medical therapy, angioplasty and stenting, and surgical revascularization. Unlike cardiac or peripheral vascular revascularization, large randomized trials with cerebrorevascularization have not revealed favorable outcomes. In patients who have failed maximal medical therapy, and having persistent debilitating symptomology, cerebral revascularization may still be a viable option.


METHODS
We report 3 patients who presented with symptoms of vertebrobasilar ischemia. The diagnosis was verified by computerized tomographic arteriography and digital subtraction angiography.


RESULTS
These patients subsequently underwent revascularization with a radial artery graft. We also present a comprehensive review of the literature of treatment for vertebrobasilar insufficiency.


CONCLUSIONS
Surgical revascularization should be considered in the posterior circulation in the rare subset of patients with VBI, who remain symptomatic despite having a protracted course of maximal medical therapy with large- and medium-sized vessel occlusions and poor collateral circulation.
Department of Neurosurgery, Methodist Hospital, Houston, Texas, USA. Electronic address: gbritz@houstonmethodist.org.
Gavin W
GW
Britz
Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
Vijay
V
Agarwal
Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
Frank
F
Mihlon
Department of Surgery, Cleveland Clinic, Cleveland, USA.
Dinesh
D
Ramanathan
Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
Abhishek
A
Agrawal
Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Shahid M
SM
Nimjee
Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
David
D
Kaylie
D000368:Aged; D015901:Angiography, Digital Subtraction; D001158:Arteries / Q000637:transplantation*; D020520:Brain Infarction / Q000000981:diagnostic imaging / Q000601:surgery; D002533:Cerebral Angiography; D002548:Cerebral Revascularization / Q000379:methods*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000175:diagnosis; D014057:Tomography, X-Ray Computed; D014715:Vertebrobasilar Insufficiency / Q000175:diagnosis / Q000601:surgery*
Dizziness; Radial artery; Revascularization; Verebrobasilar insufficiency