Surgical Revascularization Strategies for Vertebral Artery Disease

Narrowing or occlusion of the vertebral arteries may be caused by atherosclerosis, dissection, thrombosis, compression, and fibromuscular dysplasia. Vertebral artery disease can lead to reduced blood flow to the brainstem and cerebellum, resulting in a range of neurological symptoms, including vertigo, dizziness, dysarthria, and even stroke. Revascularization of the vertebral artery should be considered in symptomatic patients after failure of medical management. Restoration of blood flow may involve transluminal balloon angioplasty or stent placement; however, certain cases may still require surgical intervention. The complexity of surgical revascularization of the vertebral artery requires careful consideration of skull base and neck anatomy. While bypass procedures involving the vertebral artery may be performed for chronic steno-occlusive disease or for cerebral aneurysms, despite different indications, several key principles of the surgical technique remain. This chapter will focus on bypass of the vertebral artery in the setting of ischemic pathology, highlighting technical nuances of the procedure, preoperative planning, and postoperative management.