Profiles in Aortic and Peripheral Vascular Disease

The indications for revascularization of the vertebral arteries are symptoms of vertebrobasilar insufficiency, namely, dizziness, visual disturbances, and confusion or coma. There is a great deal of variation from patient to patient in the severity of lesions causing symptoms . In some patients the degree of stenosis may be severe yet the patient may experience minimal or no symptoms; in others there appears to be adequate flow but profound symptoms are present. The lack of correlation between the degree of stenosis and the clinical manifestations is due to variations in collateral blood supply. The posterior fossa receives blood supply from the contralateral vertebral artery and from the carotid artery system through the posterior communicating arteries. Consequently, when assessing a patient with significant stenosis of a vertebral artery, the interventionist should determine the patency of the contralateral vertebral artery, whether the diseased vertebral artery is dominant, and the amount of blood supplied to the vertebrobasilar system by the carotid arteries. (1)