VERTEBRO-BASILAR INSUFFICIENCY CAN LEAD TO POSTERIOR CIRCULATION STROKES TO THE EXTENT OF 25% BUT USUALLY GOES UNDETECTED.THIS IS AN UNFORTUNATE SITUATION FOR THE PATIENT FOR HE LANDS UP WITH STROKE AND IS HANDICAPPED FOR LIFE IF HE SURVIVES.THE UNDERLYING REASON PROBABLY IS THE SUBTLE SYMPTOMS WITH WHICH THE PATIENT FIRST APPROACHES HIS PHYSICIAN AND TO AN EXTENT THE ATTENDING DOCTORS RARELY THINK ON LINES OF VERTEBRO-BASILAR INSUFFICIENCY(VBI) AS THE UNDERLYING REASON FOR THE SYMPTOMATOLOGY WITH WHICH THE PATIENT FIRST PRESENTS TO THEM. THE PROBLEM DOES NOT END HERE.THE TREATMENT IS STILL CONTROVERSIAL .NOT MANY CASES ARE REPORTED AS COMPARED TO THE CAROTID ARTERY DISEASE WHICH IS WIDELY PREVALENT.FORTUNATELY MORE AND MORE VASCULAR SURGERY CENTRES ARE NOW GEARED UP AND THEREFORE ARE COMING UP WITH GUIDELINES AS WHEN TO INTERVENE IN PATIENTS WITH VERTEBRAL ARTERY DISEASE.THIS IS A HEALTHY SIGN.A CLOSE ASSOCIATION WITH A NEUROLOGIST CERTAINLY HELPS A BIG WAY IN PLANNING THE TREATMENT STRATEGY. WE REPORT TO YOU A SIMILAR CASE OF VERTEBRAL ARTERY DISEASE .THIS PATIENT 65 YEARS OLD MALE CAME TO US WITH SYMPTOMS OF POSTERIOR CIRCULATION. HE HAD DROP ATTACKS.FOUR VESSEL NECK DOPPLER AND SUBSEQUENTLY ANGIO REVEALED NON SIGNIFICANT DISEASE OF THE CAROTIDS. BOTH HIS VERTEBRALS WERE SIGNIFICANTLY DISEASED.THE LEFT VERTEBRAL ARTERY WAS OCCLUDED AND THE RIGHT VERTEBRAL ARTERY HAD 80%OSTIAL STENOSIS.AFTER A DETAILED DISCUSSION WITH THE NEUROLOGIST WE CONCLUDED TO INTERVENE IN THIS PATIENT.STENTING WAS AN OPTION BUT WE OPTED FOR SURGERY INSTEAD AS THE VESSEL WAS VERY TORTUOUS AND THE OSTIAL LESION WAS HEAVILY CALCIFIED.
WE WENT THROUGH THE RIGHT SUPRACLAVICULAR APPROACH AND REIMPLANTED THE RIGHT VERTEBRAL ON THE RIGHT COMMON CAROTID VESSEL.
THE PATIENT IS DOING FINE AND IS ASYMPTOMATIC TILL DATE.
