Vertebral-carotid transposition.

In the early years of evaluating patients with cerebral disease, the origins of the vertebral and subclavian arteries were not routinely visualized. Surgical intervention was more formidable then, and most symptoms were thought to be relieved by corrective carotid surgery. The continued occurrence of nonhemispheric symptoms in some patients, coupled with better techniques of diagnosis and improved surgical techniques, prompted the complete angiographic evaluation of total cerebral flow in all patients evaluated for cerebral symptoms. When carotid endarterectomy did not relieve hind brain symptoms, whether there was significant decreased vertebral flow, and whether surgical was indicated, could then be determined. Most vertebral artery occlusive disease is located near its origin and can be relieved by vertebral carotid transposition. The operative technique is described in this article along with pertinent anatomy and historical perspectives.