Efficacy of carotid endarterectomy in patients with vertebrobasilar insufficiency without significant lesion of vertebral arteries

Vachev A.N., Dmitriev O.V., Stepanov M.Yu., Frolova E.V.

Clinic of Faculty Surgery, Samara State Medical University of the RF Ministry of Public Health, Samara, Russia

The authors examined efficacy of carotid endarterectomy (CEA) in treatment of patients suffering from vertebrobasilar insufficiency (VBI) without significant involvement of the vertebral arteries.

The study included a total of 297 patients with VBI and diagnosed as having stenosis of the bifurcation of the carotid arteries amounting to 70% and more, with no significant involvement of the vertebral arteries revealed. All patients underwent CEA: eversion CEA was performed in 226 (76.1%) cases and the classical one in 71 (23.9%) cases. On postoperative day 10, clinical improvement in the form of decreased severity of VBI was observed in 152 (51.2%) patients. One year after surgery, improvement persisted in 135 (45.5%) patients and after 3 years in 125 (42%) patients.

Prognostic factors of unsatisfactory clinical outcomes were determined. It was demonstrated that in VBS, CEA is clinically efficient only if the circle of Willis is closed and there is no history of stroke in the vertebrobasilar basin. Besides, the outcome of the operation appeared to have been influenced by such factor as the duration of hypertension and diabetes mellitus. No effect of either cardiac arrhythmia or the technique of CEA on the results of treatment was observed.

KEY WORDS: carotid endarterectomy, vertebrobasilar insufficiency, surgical treatment, circle of Willis, prognostic factors.

P. 109

« Back