ROENTGENOGRAPHIC DIAGNOSIS AND SURGICAL TREATMENT OF BASILAR ARTERY INSUFFICIENCY

Abstract

Atheromatous obstructions impairing the cerebral circulation may involve the vertebral as well as the carotid arteries. Vertebral artery blood flow has been restored in a series of eight patients who had occlusive lesions in the subclavian artery proximal to the origin of the vertebral artery. In these patients the vertebral arteries themselves were not involved in the occlusive process, and it was found possible to restore normal flow through them by using bypass grafts. Localized vertebral artery obstruction may also occur in patients with basilar artery insufficiency, and this article is concerned with the technique and results of operation in a 55-year-old man whose illness began with a sudden attack of extensive paralysis and total blindness. The occlusion was complete on the right and incomplete on the left, being localized to a discrete atheroma near the origin of the vertebral artery. The partially occluding lesion was removed, and normal blood flow was restored through the vertebral artery and hence through the basilar artery. Cerebral arterial insufficiency is due to discrete extracranial occlusion in many instances, and the significance of this case lies in the fact that basilar artery circulation may be restored by surgical means as has been previously demonstrated in the treatment of occlusions of the cartoid arteries.