New Method of Determining the Success of Carotid Endarterectomy in Alleviating Symptoms Referable to the Vertebral System

Abstract

Alleviating vertebrobasilar insufficiency with carotid endarterectomy alone has ranged from a success rate of only 56% to a success rate of over 90%. Successful therapy depends on an intact circle of Willis, absence of stenotic lesions in the small vessels of the posterior and anterior system, and the occurrence of posterior symptoms as a result of hypoperfusion of the vertebral artery. Barring variables, an increase in perfusion through the internal carotid artery should result in an increase in perfusion of the vertebral system. If this occurs, we should expect symptomatic relief of posterior symptoms secondary to an increase in blood flow. We believe measurements of back pressures in the vertebral artery before and after endarterectomy may identify those patients needing a combined approach.