Carotid to Foraminal Vertebral Artery Bypass for Symptomatic Vertebrobasilar Insufficiency
Travis Hughes, Eric Endean, David Minion, Samuel Tyagi
University of Kentucky, Lexington, KY
INTRODUCTION: Treatment of symptomatic vertebrobasilar insufficiency with lesions in the V2 segment have limited options for revascularization. Classically direct revascularization of the V2 segment has been avoided due to inaccessibility of the vessel within the transverse foramen. We present a patient with symptomatic vertebrobasilar insufficiency due to a long segment severe stenosis of the right vertebral artery from its origin to the proximal V2 segment and left vertebral artery hypoplasia.
METHODS: We reviewed a single case of symptomatic vertebrobasilar insufficiency with lesion from the vertebral artery origin to the proximal V2 segment.
RESULTS: A right common carotid to vertebral artery bypass (V2) with greater saphenous vein was performed. Access was gained to the vertebral artery within the transverse foramen via resection of the anterior tubercle of the C5 and C6 right transverse process, while protecting the artery and vein with a right angle. Post operatively the patient developed a hematoma that resolved by his post-operative follow up. He was discharged on post-operative day six. He has had resolution of his vertebrobasilar symptoms.
CONCLUSIONS: We demonstrate that the foraminal vertebral artery can be accessed with resection of the transverse process. Bypass to this segment can be safely performed with resolution of vertebrobasilar symptoms in properly selected patients.
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