Reconstruction for Symptomatic Vertebral Artery Lesion Using Vertebral Artery to Carotid Artery Transposition: A Retrospective Study

A posterior circulation infarction is caused by a vertebral artery (VA) lesion (stenosis or occlusion). The purpose of this study is to assess early and long-term outcomes after open surgery for a VA lesion at the origin. In a retrospective study conducted from January 1, 2000 through March 31, 2020 in a single center, patients were treated with vertebral artery to carotid artery transposition (VCT). A total of 28 patients, with a mean age of 65.29 ± 9.81 years (range 45–84), were screened, including 22 patients with VA stenosis and 6 patients with VA occlusion. The complication rate was 21.4% (n = 6), including Horner syndrome (n = 2), lymphocele (n = 1), respiratory failure (n = 1), embolism of a subclavian artery stenosis (n = 1), and vocal cord paralysis (n = 1). The 30-day mortality rate was 0%. Primary patency was 100%. Overall, improvement in symptoms was 85.7% (n = 24) after surgery and 96.4% after 30 days. In the long-term results, primary patency was 100%, and the cumulative patency rate after 60 months was 85.7%, with 1 occlusion of the VA. Cumulative survival rates were 94%, 87%, 69%, and 59% after 12, 24, 60, and 72 months (n = 5). One of the 3 patients died after 60 months because of VA occlusion and posterior circulation infarction. VCT is a safe, effective, and durable procedure. It provides good stroke protection, symptomatic relief, and perioperative risk at acceptable levels, in experienced hands. •A retrospective study in a single center.•The complication rate of VCT reconstruction was 14.3% (n = 4) with Grade I, 3.6% (n = 1) with Grade IIIa and 3.6% (n = 1) with Grade IVa according to Clavien-Dindo classification. The 30-day mortality rate was 0%. Primary patency was 100%, without a vascular complication. Overall, improvement in symptoms was 96.4% after 30 days (n = 27).•Primary patency was 100%. The cumulative patency rate was 85.7% after 60 months.•Comparing the two procedures, open surgery has an equal value to endovascular therapy, with a good long-term outcome.•Open surgery for symptomatic vertebral artery lesions is a safe, effective and durable procedure, considering the long-term outcomes.•VCT provides good stroke protection, symptomatic relief, and perioperative risk at acceptable levels, in experienced hands.