Vertebrobasilar insufficiency

Part 1: Microsurgical treatment of extracranial vertebrobasilar disease

View More View Less
  • 1 Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, and Dent Neurologic Institute of Millard Fillmore Hospital and Department of Neurosurgery, State University of New York, Buffalo, New York
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $45.00
USD  $515.00
USD  $612.00
Print or Print + Online Sign in

✓ Extracranial vertebrobasilar artery thrombo-occlusive disease may cause repetitive transient ischemic episodes and, less frequently, brain-stem or cerebellar infarction. This report describes 40 patients who experienced repetitive vertebrobasilar ischemic symptoms despite maximal medical therapy. The natural history, pathogenesis, and treatment options for each causative lesion are reviewed. The operative approaches to symptomatic disease of the proximal vertebral arteries, arterial compression by cervical osteophytes, traumatic lesions of the vertebral arteries, and thrombo-occlusive pathology of the distal extracranial vertebral arteries are outlined. Specific anesthetic and surgical techniques that have proved successful while achieving zero operative mortality and low perioperative morbidity rates are reported.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $515.00
USD  $612.00
  • 1.

    Ausman JI, , Diaz FG, & de los Reyes RA: Vertebral artery atherosclerosis, in Wilkins RH, & Rengachary SS (eds): Neurosurgery. New York: McGraw-Hill, 1985, pp 12481254 Ausman JI, Diaz FG, de los Reyes RA: Vertebral artery atherosclerosis, in Wilkins RH, Rengachary SS (eds): Neurosurgery. New York: McGraw-Hill, 1985, pp 1248–1254

    • Search Google Scholar
    • Export Citation
  • 2.

    Bohmfalk GL, , Story JL, & Brown WE Jr, et al: Subclavian steal syndrome. Part 1: Proximal vertebral to common carotid artery transposition in three patients, and historical review. J Neurosurg 51:628640, 1979 Bohmfalk GL, Story JL, Brown WE Jr, et al: Subclavian steal syndrome. Part 1: Proximal vertebral to common carotid artery transposition in three patients, and historical review. J Neurosurg 51:628–640, 1979

    • Search Google Scholar
    • Export Citation
  • 3.

    Bohmfalk GL, , Story JL, & Brown WR Jr, et al: Subclavian steal syndrome. Part 2: Intraoperative vertebral artery blood flow measurement. J Neurosurg 51:641643, 1979 Bohmfalk GL, Story JL, Brown WR Jr, et al: Subclavian steal syndrome. Part 2: Intraoperative vertebral artery blood flow measurement. J Neurosurg 51:641–643, 1979

    • Search Google Scholar
    • Export Citation
  • 4.

    Camp PE: Carotid to distal vertebral artery bypass for vertebrobasilar ischemia. Case report. J Neurosurg 60:187189, 1984 Camp PE: Carotid to distal vertebral artery bypass for vertebrobasilar ischemia. Case report. J Neurosurg 60:187–189, 1984

    • Search Google Scholar
    • Export Citation
  • 5.

    The Canadian Cooperative Study Group: A randomized trial of aspirin and sulfinpyrazone in threatened stroke. N Engl J Med 299:5359, 1978 The Canadian Cooperative Study Group: A randomized trial of aspirin and sulfinpyrazone in threatened stroke. N Engl J Med 299:53–59, 1978

    • Search Google Scholar
    • Export Citation
  • 6.

    Caplan LR: Vertebrobasilar disease. Time for a new strategy. Stroke 12:111114, 1981 Caplan LR: Vertebrobasilar disease. Time for a new strategy. Stroke 12:111–114, 1981

    • Search Google Scholar
    • Export Citation
  • 7.

    Carney AL: Vertebral artery surgery: historical development, basic concepts of brain hemodynamics, and clinical experience of 102 cases, in Carney AL, & Anderson EM (eds): Diagnosis and Treatment of Brain Ischemia. CT Brain Blood Flow, Brain Hemodynamics, and Carotid and Vertebral Artery Surgery. Advances in Neurology, Vol 30. New York: Raven Press, 1981, pp 249282 Carney AL: Vertebral artery surgery: historical development, basic concepts of brain hemodynamics, and clinical experience of 102 cases, in Carney AL, Anderson EM (eds): Diagnosis and Treatment of Brain Ischemia. CT Brain Blood Flow, Brain Hemodynamics, and Carotid and Vertebral Artery Surgery. Advances in Neurology, Vol 30. New York: Raven Press, 1981, pp 249–282

    • Search Google Scholar
    • Export Citation
  • 8.

    Cartlidge NEF, , Whisnant JP, & Elveback LR: Carotid and vertebral-basilar transient cerebral ischemic attacks. A community study, Rochester, Minnesota. Mayo Clin Proc 52:117120, 1977 Cartlidge NEF, Whisnant JP, Elveback LR: Carotid and vertebral-basilar transient cerebral ischemic attacks. A community study, Rochester, Minnesota. Mayo Clin Proc 52:117–120, 1977

    • Search Google Scholar
    • Export Citation
  • 9.

    Castaigne P, , Lhermitte F, & Gautier JC, et al: Arterial occlusions in the vertebro-basilar system. A study of 44 patients with post-mortem data. Brain 96:133154, 1973 Castaigne P, Lhermitte F, Gautier JC, et al: Arterial occlusions in the vertebro-basilar system. A study of 44 patients with post-mortem data. Brain 96:133–154, 1973

    • Search Google Scholar
    • Export Citation
  • 10.

    Corkill G, , French BN, & Michas C, et al: External carotid-vertebral artery anastomosis for vertebrobasilar insufficiency. Surg Neurol 7:109115, 1977 Corkill G, French BN, Michas C, et al: External carotid-vertebral artery anastomosis for vertebrobasilar insufficiency. Surg Neurol 7:109–115, 1977

    • Search Google Scholar
    • Export Citation
  • 11.

    Courtheoux P, , Tournade A, & Theron J, et al: Transcutaneous angioplasty of vertebral artery atheromatous ostial stricture. Neuroradiology 27:259264, 1985 Courtheoux P, Tournade A, Theron J, et al: Transcutaneous angioplasty of vertebral artery atheromatous ostial stricture. Neuroradiology 27:259–264, 1985

    • Search Google Scholar
    • Export Citation
  • 12.

    Davidson KC, , Weiford EC, & Dixon GD: Traumatic vertebral artery pseudoaneurysm following chiropractic manipulation. Radiology 115:651652, 1975 Davidson KC, Weiford EC, Dixon GD: Traumatic vertebral artery pseudoaneurysm following chiropractic manipulation. Radiology 115:651–652, 1975

    • Search Google Scholar
    • Export Citation
  • 13.

    de los Reyes RA, , Ausman JI, & Diaz FG, et al: The surgical management of vertebrobasilar insufficiency. Acta Neurochir 68:203216, 1983 de los Reyes RA, Ausman JI, Diaz FG, et al: The surgical management of vertebrobasilar insufficiency. Acta Neurochir 68:203–216, 1983

    • Search Google Scholar
    • Export Citation
  • 14.

    Dyken ML: Anticoagulant and platelet-antiaggregating therapy in stroke and threatened stroke. Neurol Clin 1:223242, 1983 Dyken ML: Anticoagulant and platelet-antiaggregating therapy in stroke and threatened stroke. Neurol Clin 1:223–242, 1983

    • Search Google Scholar
    • Export Citation
  • 15.

    Edwards WH, & Mulherin JL Jr: The surgical reconstruction of the proximal subclavian and vertebral artery, in Berguer R, & Bauer RB (eds): Vertebrobasilar Arterial Occlusive Disease. Medical and Surgical Management. New York: Raven Press, 1984, pp 241256 Edwards WH, Mulherin JL Jr: The surgical reconstruction of the proximal subclavian and vertebral artery, in Berguer R, Bauer RB (eds): Vertebrobasilar Arterial Occlusive Disease. Medical and Surgical Management. New York: Raven Press, 1984, pp 241–256

    • Search Google Scholar
    • Export Citation
  • 16.

    Feldman AJ: Surgical approach to disease of the first portion of the vertebral artery, in Berguer R, & Bauer RB (eds): Vertebrobasilar Arterial Occlusive Disease. Medical and Surgical Management. New York: Raven Press, 1984, pp 231240 Feldman AJ: Surgical approach to disease of the first portion of the vertebral artery, in Berguer R, Bauer RB (eds): Vertebrobasilar Arterial Occlusive Disease. Medical and Surgical Management. New York: Raven Press, 1984, pp 231–240

    • Search Google Scholar
    • Export Citation
  • 17.

    Fields WS, & Lemak NA: Joint study of extracranial arterial occlusion. VII. Subclavian steal — a review of 168 cases. JAMA 222:11391143, 1972 Fields WS, Lemak NA: Joint study of extracranial arterial occlusion. VII. Subclavian steal — a review of 168 cases. JAMA 222:1139–1143, 1972

    • Search Google Scholar
    • Export Citation
  • 18.

    Fisher CM: Occlusion of the vertebral arteries. Causing transient basilar symptoms. Arch Neurol 22:1319, 1970 Fisher CM: Occlusion of the vertebral arteries. Causing transient basilar symptoms. Arch Neurol 22:13–19, 1970

    • Search Google Scholar
    • Export Citation
  • 19.

    Fisher CM, , Gore I, & Okabe N, et al: Atherosclerosis of the carotid and vertebral arteries — extracranial and intracranial. J Neuropathol Exp Neurol 24:455476, 1965 Fisher CM, Gore I, Okabe N, et al: Atherosclerosis of the carotid and vertebral arteries — extracranial and intracranial. J Neuropathol Exp Neurol 24:455–476, 1965

    • Search Google Scholar
    • Export Citation
  • 20.

    Fisher CM, & Karnes WE: Local embolism. J Neuropathol Exp Neurol 24:174175, 1965 (Abstract) Fisher CM, Karnes WE: Local embolism. J Neuropathol Exp Neurol 24:174–175, 1965 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 21.

    George B, & Laurian C: Surgical approach to the whole length of the vertebral artery with special reference to the third portion. Acta Neurochir 51:259272, 1980 George B, Laurian C: Surgical approach to the whole length of the vertebral artery with special reference to the third portion. Acta Neurochir 51:259–272, 1980

    • Search Google Scholar
    • Export Citation
  • 22.

    George B, & Laurian C: Vertebro-basilar ischaemia with thrombosis of the vertebral artery: report of two cases with embolism. J Neurol Neurosurg Psychiatry 45:9193, 1982 George B, Laurian C: Vertebro-basilar ischaemia with thrombosis of the vertebral artery: report of two cases with embolism. J Neurol Neurosurg Psychiatry 45:91–93, 1982

    • Search Google Scholar
    • Export Citation
  • 23.

    Hadley MN, , Masferrer R, & Zabramski J, et al: Management of vertebrobasilar insufficiency, in Spetzler RF, , Carter LP, & Selman WR, et al (eds): Cerebral Revascularization for Stroke. New York: Thieme-Stratton, 1985, pp 475482 Hadley MN, Masferrer R, Zabramski J, et al: Management of vertebrobasilar insufficiency, in Spetzler RF, Carter LP, Selman WR, et al (eds): Cerebral Revascularization for Stroke. New York: Thieme-Stratton, 1985, pp 475–482

    • Search Google Scholar
    • Export Citation
  • 24.

    Hadley MN, , Spetzler RF, & Masferrer R, et al: Occipital artery to extradural vertebral artery bypass procedure. Case report. J Neurosurg 63:622625, 1985 Hadley MN, Spetzler RF, Masferrer R, et al: Occipital artery to extradural vertebral artery bypass procedure. Case report. J Neurosurg 63:622–625, 1985

    • Search Google Scholar
    • Export Citation
  • 25.

    Hardin CA, & Poser CM: Rotational obstruction of the vertebral artery due to redundancy and extraluminal cervical fascial bands. Ann Surg 158:133137, 1963 Hardin CA, Poser CM: Rotational obstruction of the vertebral artery due to redundancy and extraluminal cervical fascial bands. Ann Surg 158:133–137, 1963

    • Search Google Scholar
    • Export Citation
  • 26.

    Heyman A, , Wilkinson WE, & Hurwitz BJ, et al: Clinical and epidemiologic aspects of vertebrobasilar and nonfocal cerebral ischemia, in Berguer R, & Bauer RB (eds): Vertebrobasilar Arterial Occlusive Disease. Medical and Surgical Management. New York: Raven Press, 1984, pp 2736 Heyman A, Wilkinson WE, Hurwitz BJ, et al: Clinical and epidemiologic aspects of vertebrobasilar and nonfocal cerebral ischemia, in Berguer R, Bauer RB (eds): Vertebrobasilar Arterial Occlusive Disease. Medical and Surgical Management. New York: Raven Press, 1984, pp 27–36

    • Search Google Scholar
    • Export Citation
  • 27.

    Heyman A, , Young WG Jr, & Dillon M, et al: Cerebral ischemia caused by occlusive lesions of the subclavian or innominate arteries. Arch Neurol 10:581589, 1964 Heyman A, Young WG Jr, Dillon M, et al: Cerebral ischemia caused by occlusive lesions of the subclavian or innominate arteries. Arch Neurol 10:581–589, 1964

    • Search Google Scholar
    • Export Citation
  • 28.

    Hopkins LN, & Budny JL: A rational surgical approach to vertebrobasilar ischemia, in Spetzler RF, , Carter LP, & Selman WR, et al (eds): Cerebral Revascularization for Stroke. New York: Thieme-Stratton, 1985, pp 490501 Hopkins LN, Budny JL: A rational surgical approach to vertebrobasilar ischemia, in Spetzler RF, Carter LP, Selman WR, et al (eds): Cerebral Revascularization for Stroke. New York: Thieme-Stratton, 1985, pp 490–501

    • Search Google Scholar
    • Export Citation
  • 29.

    Hutchinson EC, & Yates PO: The cervical portion of the vertebral artery. A clinico-pathological study. Brain 79:319331, 1956 Hutchinson EC, Yates PO: The cervical portion of the vertebral artery. A clinico-pathological study. Brain 79:319–331, 1956

    • Search Google Scholar
    • Export Citation
  • 30.

    Imparato AM, , Riles TS, & Kim GE: Cervical vertebral angioplasty for brain stem ischemia. Surgery 90:842852, 1981 Imparato AM, Riles TS, Kim GE: Cervical vertebral angioplasty for brain stem ischemia. Surgery 90:842–852, 1981

    • Search Google Scholar
    • Export Citation
  • 31.

    Jones HR Jr, , Millikan CH, & Sandok BA: Temporal profile (clinical course) of acute vertebrobasilar system cerebral infarction. Stroke 11:173177, 1980 Jones HR Jr, Millikan CH, Sandok BA: Temporal profile (clinical course) of acute vertebrobasilar system cerebral infarction. Stroke 11:173–177, 1980

    • Search Google Scholar
    • Export Citation
  • 32.

    Katirji MB, , Reinmuth OM, & Latchaw RE: Stroke due to vertebral artery injury. Arch Neurol 42:242248, 1985 Katirji MB, Reinmuth OM, Latchaw RE: Stroke due to vertebral artery injury. Arch Neurol 42:242–248, 1985

    • Search Google Scholar
    • Export Citation
  • 33.

    Kieffer E, , Rancurel G, & Richard T: Reconstruction of the distal cervical vertebral artery, in Berguer R, & Bauer RB (eds): Vertebrobasilar Arterial Occlusive Disease. Medical and Surgical Management. New York: Raven Press, 1984, pp 265290 Kieffer E, Rancurel G, Richard T: Reconstruction of the distal cervical vertebral artery, in Berguer R, Bauer RB (eds): Vertebrobasilar Arterial Occlusive Disease. Medical and Surgical Management. New York: Raven Press, 1984, pp 265–290

    • Search Google Scholar
    • Export Citation
  • 34.

    Killen DA, , Foster JH, & Gobbel WG Jr, et al: The subclavian steal syndrome. J Thorac Cardiovasc Surg 51:539560, 1966 Killen DA, Foster JH, Gobbel WG Jr, et al: The subclavian steal syndrome. J Thorac Cardiovasc Surg 51:539–560, 1966

    • Search Google Scholar
    • Export Citation
  • 35.

    Koroshetz WJ, & Ropper AH: Local embolism as a cause of stroke in the posterior circulation. Neurology 35 (Suppl 1):214, 1985 (Abstract) Koroshetz WJ, Ropper AH: Local embolism as a cause of stroke in the posterior circulation. Neurology 35 (Suppl 1):214, 1985 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 36.

    Kubik CS, & Adams RD: Occlusion of the basilar artery — a clinical and pathological study. Brain 69:73121, 1946 Kubik CS, Adams RD: Occlusion of the basilar artery — a clinical and pathological study. Brain 69:73–121, 1946

    • Search Google Scholar
    • Export Citation
  • 37.

    Mandelbaum I, , Nahrwold DL, & Dzenitis AJ: Spontaneous resolution of traumatic subclavian steal syndrome. Ann Surg 165:314317, 1967 Mandelbaum I, Nahrwold DL, Dzenitis AJ: Spontaneous resolution of traumatic subclavian steal syndrome. Ann Surg 165:314–317, 1967

    • Search Google Scholar
    • Export Citation
  • 38.

    Mapstone T, & Spetzler RF: Vertebrobasilar insufficiency secondary to vertebral artery occlusion from a fibrous band. Case report. J Neurosurg 56:581583, 1982 Mapstone T, Spetzler RF: Vertebrobasilar insufficiency secondary to vertebral artery occlusion from a fibrous band. Case report. J Neurosurg 56:581–583, 1982

    • Search Google Scholar
    • Export Citation
  • 39.

    McDowell FH, , Potes J, & Groch S: The natural history of internal carotid and vertebral-basilar artery occlusion. Neurology 11 (No. 4, Part 2):153157, 1961 McDowell FH, Potes J, Groch S: The natural history of internal carotid and vertebral-basilar artery occlusion. Neurology 11 (No. 4, Part 2):153–157, 1961

    • Search Google Scholar
    • Export Citation
  • 40.

    Meier DE, , Brink BE, & Fry WJ: Vertebral artery trauma. Acute recognition and treatment. Arch Surg 116:236239, 1981 Meier DE, Brink BE, Fry WJ: Vertebral artery trauma. Acute recognition and treatment. Arch Surg 116:236–239, 1981

    • Search Google Scholar
    • Export Citation
  • 41.

    Millikan CH, , Siekert RG, & Shick RM: Studies in cerebrovascular disease. III. The use of anticoagulant drugs in the treatment of insufficiency or thrombosis within the basilar arterial system. Proc Staff Meet Mayo Clin 30:116126, 1955 Millikan CH, Siekert RG, Shick RM: Studies in cerebrovascular disease. III. The use of anticoagulant drugs in the treatment of insufficiency or thrombosis within the basilar arterial system. Proc Staff Meet Mayo Clin 30:116–126, 1955

    • Search Google Scholar
    • Export Citation
  • 42.

    Moore WS, & Hall AD: Ulcerated atheroma of the carotid artery. A cause of transient cerebral ischemia. Am J Surg 116:237242, 1968 Moore WS, Hall AD: Ulcerated atheroma of the carotid artery. A cause of transient cerebral ischemia. Am J Surg 116:237–242, 1968

    • Search Google Scholar
    • Export Citation
  • 43.

    Moufarrij NA, , Little JR, & Furlan AJ, et al: Vertebral artery stenosis: long-term follow-up. Stroke 15:260263, 1984 Moufarrij NA, Little JR, Furlan AJ, et al: Vertebral artery stenosis: long-term follow-up. Stroke 15:260–263, 1984

    • Search Google Scholar
    • Export Citation
  • 44.

    Nagashima C: Surgical treatment of vertebral artery insufficiency caused by cervical spondylosis. J Neurosurg 32:512521, 1970 Nagashima C: Surgical treatment of vertebral artery insufficiency caused by cervical spondylosis. J Neurosurg 32:512–521, 1970

    • Search Google Scholar
    • Export Citation
  • 45.

    Naritomi H, , Sakai F, & Meyer JS: Pathogenesis of transient ischemic attacks within the vertebrobasilar arterial system. Arch Neurol 36:121128, 1979 Naritomi H, Sakai F, Meyer JS: Pathogenesis of transient ischemic attacks within the vertebrobasilar arterial system. Arch Neurol 36:121–128, 1979

    • Search Google Scholar
    • Export Citation
  • 46.

    Pásztor E: Decompression of vertebral artery in cases of cervical spondylosis. Surg Neurol 9:371377, 1978 Pásztor E: Decompression of vertebral artery in cases of cervical spondylosis. Surg Neurol 9:371–377, 1978

    • Search Google Scholar
    • Export Citation
  • 47.

    Patrick BK, , Ramirez-Lassepas M, & Snyder BD: Temporal profile of vertebrobasilar territory infarction. Prognostic implications. Stroke 11:643648, 1980 Patrick BK, Ramirez-Lassepas M, Snyder BD: Temporal profile of vertebrobasilar territory infarction. Prognostic implications. Stroke 11:643–648, 1980

    • Search Google Scholar
    • Export Citation
  • 48.

    Solberg LA, & Eggen DA: Localization and sequence of development of atherosclerotic lesions in the carotid and vertebral arteries. Circulation 43:711724, 1971 Solberg LA, Eggen DA: Localization and sequence of development of atherosclerotic lesions in the carotid and vertebral arteries. Circulation 43:711–724, 1971

    • Search Google Scholar
    • Export Citation
  • 49.

    Spetzler RF, & Hadley MN: Revascularization of the brainstem and posterior fossa, in Samii M (ed): Surgery On and Around the Brainstem and Third Ventricle. New York: Springer-Verlag, 1986, pp 262269 Spetzler RF, Hadley MN: Revascularization of the brainstem and posterior fossa, in Samii M (ed): Surgery On and Around the Brainstem and Third Ventricle. New York: Springer-Verlag, 1986, pp 262–269

    • Search Google Scholar
    • Export Citation
  • 50.

    Story JL, , Brown WE Jr, & Ansell LV, et al: The management of vertebrobasilar insufficiency by extracranial surgical procedures, in Smith RR (ed): Stroke and the Extracranial Vessels. New York: Raven Press, 1984, pp 227254 Story JL, Brown WE Jr, Ansell LV, et al: The management of vertebrobasilar insufficiency by extracranial surgical procedures, in Smith RR (ed): Stroke and the Extracranial Vessels. New York: Raven Press, 1984, pp 227–254

    • Search Google Scholar
    • Export Citation
  • 51.

    Sullivan HG, , Harbison JW, & Vines FS, et al: Embolic posterior cerebral artery occlusion secondary to spondylitic vertebral artery compression. Case report. J Neurosurg 43:618622, 1975 Sullivan HG, Harbison JW, Vines FS, et al: Embolic posterior cerebral artery occlusion secondary to spondylitic vertebral artery compression. Case report. J Neurosurg 43:618–622, 1975

    • Search Google Scholar
    • Export Citation
  • 52.

    Sundt TM Jr, , Campbell JK, & Houser OW: Transpositions and anastomoses between the posterior cerebral and superior cerebellar arteries. Report of two cases. J Neurosurg 55:967970, 1981 Sundt TM Jr, Campbell JK, Houser OW: Transpositions and anastomoses between the posterior cerebral and superior cerebellar arteries. Report of two cases. J Neurosurg 55:967–970, 1981

    • Search Google Scholar
    • Export Citation
  • 53.

    Weksler BB, & Lewin M: Anticoagulation in cerebral ischemia. Stroke 14:658663, 1983 Weksler BB, Lewin M: Anticoagulation in cerebral ischemia. Stroke 14:658–663, 1983

    • Search Google Scholar
    • Export Citation
  • 54.

    Wheeler HB: Surgical treatment of subclavian-artery occlusions. N Engl J Med 276:711717, 1967 Wheeler HB: Surgical treatment of subclavian-artery occlusions. N Engl J Med 276:711–717, 1967

    • Search Google Scholar
    • Export Citation
  • 55.

    Whisnant JP, , Cartlidge NEF, & Elveback LR: Carotid and vertebral-basilar transient ischemic attacks: effects of anticoagulants, hypertension, and cardiac disorders on survival and stroke occurrence — a population study. Ann Neurol 3:107115, 1978 Whisnant JP, Cartlidge NEF, Elveback LR: Carotid and vertebral-basilar transient ischemic attacks: effects of anticoagulants, hypertension, and cardiac disorders on survival and stroke occurrence — a population study. Ann Neurol 3:107–115, 1978

    • Search Google Scholar
    • Export Citation
  • 56.

    Wilkinson E, , Spetzler RF, & Carter LP, et al: Intraoperative barbiturate therapy during temporary vessel occlusion in man, in Spetzler RF, , Carter LP, & Selman WR (eds): Cerebral Revascularization for Stroke. New York: Thieme-Stratton, 1985, pp 397402 Wilkinson E, Spetzler RF, Carter LP, et al: Intraoperative barbiturate therapy during temporary vessel occlusion in man, in Spetzler RF, Carter LP, Selman WR (eds): Cerebral Revascularization for Stroke. New York: Thieme-Stratton, 1985, pp 397–402

    • Search Google Scholar
    • Export Citation
  • 57.

    Wylie EJ, & Effeney DJ: Surgery of the aortic arch branches and vertebral arteries. Surg Clin North Am 59:669680, 1979 Wylie EJ, Effeney DJ: Surgery of the aortic arch branches and vertebral arteries. Surg Clin North Am 59:669–680, 1979

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 1087 239 5
Full Text Views 362 11 3
PDF Downloads 188 11 5
EPUB Downloads 0 0 0