Achievements and Prospects for Vascular Surgery in Treatment of Vertebrobasilar Insufficiency

Vertebrobasilar insufficiency (VBI) remains an important problem in the modern medicine since approximately every fourth cerebral infarction occurs in the posterior circulation of the brain. These strokes are accompanied by severe consequences and a high risk of repeated events. The article presents the current concepts for surgical treatment of lesions of the subclavian (ScA) and vertebral (VA) arteries responsible for the development of VBI. In the open surgical treatment of symptomatic lesion of the ScA, primarily of occlusion one, extrathoracic interventions prevail in the form of carotid-subclavian bypass and carotid-subclavian transposition. According to our analysis, the results of carotid-subclavian transposition prove to be more preferable. In the endovascular intervention on the ScA, balloon angioplasty is used with possible stenting. In the analysis, we found no differences in the long-term patency between angioplasty and stenting, although the extent of technical success was higher in the group of stenting. In case of stenosis of the ScA, the world medicine gives priority to endovascular methods. To date, there are no sharply defined criteria permitting to choose between the open and endovascular interventions for treatment of the ScA occlusion, although a probable technical failure of endovascular revascularization and higher long-term patency give priority to open surgery. As for symptomatic stenosis of VA, to date there is no evidence of the advantage of stenting over conservative therapy. Thus, surgical intervention should rather be used in case the drug treatment is ineffective. The same can be said about the open reconstruction of the VA, except for the cases of contraindications for stenting of the VA, for example, its tortuosity.