Vertebral artery revascularization

Ischemia of the posterior circulation related to diseases of the vertebral artery is associated with a significant incidence of delayed stroke and morbidity. Although medical therapies, including anticoagulant and antiplatelet agents, typically are used as the first line of treatment, many surgical techniques are available for the management of refractory cases. Atheroclerosis and compression by fascial bands or osteophytes represent the most frequent types of pathology affecting the vertebral artery. Surgical techniques vary according to the location and type of disease process. Vertebral endarterectomy, transpositions, and bypasses are discussed, and surgical approaches are reviewed in the context of the location and type of disease.