[A case of combined reconstruction of extracranial vertebral and carotid artery stenosis].

A 67-year-old man was admitted for status epilepticus, right hemiparesis, repeating vertigo and vomiting. Computed tomography showed no abnormality except for slight brain atrophy. Angiogram demonstrated bilateral vertebral artery stenosis at the origin, especially on the left side, and bilateral cervical internal carotid artery stenosis associated with ulceration. Intracranially, bilateral anterior cerebral artery was filled only by right internal carotid artery. Internal carotid artery on both sides did not fill the posterior cerebral artery. From these findings, we thought that both bilateral internal carotid artery and left vertebral artery should be surgically reconstructed. On June 4, 1986, left vertebral transposition to the common carotid artery and left carotid endarterectomy using double-balloon shunt were performed. Waiting for recovery of the general condition, right carotid endarterectomy was carried out on June 27, 1986. Postoperative angiogram demonstrated disappearance of bilateral internal carotid artery stenosis, and good filling of left vertebral artery through left common carotid artery. Postoperative course was uneventful and right hemiparesis gradually improved. Vertigo and vomiting completely subsided. The method and indication of combined reconstruction for extracranial vertebral and carotid artery were discussed.