The Optimal Method of Reconstruction of the Atherosclerotic Stenosed Vertebral Artery in the First Segment

Roman Komarov, Oleg Vinogradov, Andrey Dzyundzya, Aleksey Puzanov

I.M. Sechenov First Moscow State Medical University, Moscow, Russia

Date, time and location: 2018.05.25 15:30, Congress Hall, 2F–B

Abstract

Objective: To evaluate the results of reconstructive interventions on the first segment of vertebral artery (VA) with it's significant stenosis.

Materials and methods: From 2009 to 2017, 72 patients with significant stenosis of the VA in 1 segment were treated in the cardiosurgery department. Men - 52 (72.2%), women - 20 (27.8%). Patients were divided into two groups. Group I consisted of 40 patients (55.6%) who underwent an eversion endarterectomy from the vertebral artery with reimplantation in the former estuary. Group II consisted of 32 patients (44.4%) who underwent an eversion endarterectomy from the vertebral artery with the formation of a new aperture of a vessel in the 2nd segment of the subclavian artery.

Results: In the early postoperative period, within the 1^st group there was 1 case (3.3%) of thrombosis of operated VA without focal neurologic symptoms and 1 case (3.3%) of bleeding occurred due to anastomosis suture cutting. In group II there were no complications. In all cases of reimplantation of VA, atherosclerotic involvement of the subclavian artery wall in segment 2 was not noted. In the long-term period (2 years after the operation), in the I group, there were revealed 3 cases (10%) of hemodynamically significant restenosis in the VA estuary area with recurrence of the clinical picture of vertebro-basilar insufficiency. In the 2 group, restenosis was not detected in the long-term period.

Conclusion: The second segment of the subclavian artery is the least susceptible to atherosclerotic lesion. The application of anastomosis between the VA and the second segment of the subclavian artery is safe and more promising in terms of the development of restenosis in the distant period. The operation of choice may be an eversion endarterectomy from the VA with reimplantation of the 2 segment of the subclavian artery into the new estuary.