• World Neurosurg · Feb 2021

    Case Reports Observational Study

    Minimally Invasive Surgical Repair of Vertebral Artery Ostium Stenosis in Ischemic Stroke Patients: a single-centre case series.

    • Riste Zimoski, Petar Ugurov, Lidija Veljanoska-Kiridjievska, Nikola Hristov, Enver Idoski, Marko Gjorgon, Neda Milevska-Kostova, Rodney Alexander Rosalia, and Zan Mitrev.
    • Department of Cardiovascular Surgery, Zan Mitrev Clinic, Skopje, Republic of North Macedonia.
    • World Neurosurg. 2021 Feb 1; 146: 367-375.e2.

    BackgroundIschemic stroke is the second leading cause of death in North Macedonia. Posterior circulation disease, caused by vertebral artery (VA) ostium (VAo) stenosis, is a common cause of ischemic stroke. We established a treatment approach using surgical revascularization of posterior circulation disease. In the present observational study, we assessed the outcome after surgical revascularization of the posterior circulation ischemia caused by VAo stenosis.MethodsA retrospective analysis of 20 consecutive patients who had undergone surgery from January 2017 to December 2019. The VA was accessed through a 3-cm incision in the upper medial clavicle. The corrective procedures consisted of resection and anastomosis (15 of 20), VA to subclavian artery transposition (16 of 20), endarterectomy (10 of 20), vein graft interposition techniques (4 of 20), and vein graft bypass (1 of 20).ResultsThe cohort included 9 acute cases. The mean patient age was 66.5 years (range 46-77). Of the 20 patients, 8 were women and 12 were men. Left-sided VA pathology was present in 75% of the cases. We observed rapid clinical improvement in 19 patients (95%). The total study period was 321 patient-months, with a median follow-up of 18 months (interquartile range, 5-24 months). One patient had died of an unknown cause after 12 months. During the follow-up period, 15 patients (75%) had reported permanent clinical improvement with no significant relapse of symptoms.ConclusionsMinimally invasive surgical revascularization of the posterior brain circulation is a clinically effective therapeutic approach to manage ischemia caused by VAo stenosis. It can be performed safely, promote long-lasting symptom relief, and prevent recurrent strokes.Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.

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