The surgical approach to significant stenosis of vertebral and subclavian arteries.

Nonhemispheric transient ischemic attacks (TIAs) occur as a result of diminished flow to the basilar artery and its branches. The importance of the four major sources of blood supply have been emphasized. Angiographic evaluation of 1,700 patients with cerebral symptoms revealed significant subclavian or vertebral stenosis in 244. Since 1972 a direct anastomosis to the adjacent common carotid artery has been the selected operative procedure to restore flow to distal arteries. Exposure and completion of the anastomosis requires only a supraclavicular approach and can be performed safely. No deaths or neurological deficits as a result of interruption of cerebral flow have occurred. Complications have been minor.