C2 pedicle screw insertion assisted by mobilization of the vertebral artery in cases with high-riding vertebral artery.

Objective: To describe the feasibility, safety and efficacy of mobilization of the vertebral artery for C2 pedicle screws in cases with the high-riding vertebral artery (HRVA).. Methods: During the period January 2020 to September 2022, fifteen patients underwent posterior occipitocervical fixation in our department. All patients had unilateral HRVA on at least one side that prohibited the insertion of C2 pedicle screws. There were 2 males and 13 females aged 47 ± 11.9 years (range: 17-64 years). After the correction of the vertical dislocation during the operation, the C2 pedicle screw insertion and occipitocervical fixation and fusion were performed using the vertebral artery mobilization technique. A routine three-dimensional reconstructed CT examination was executed to confirm the trajectory of C2 pedicle screws post-operation, and a CT angiography examination was performed when necessary. Neurological function was assessed using the Japanese Orthopedic Association (JOA) scale. The preoperative and postoperative JOA score and the main radiological measurements, including anterior atlantodental interval (ADI), the distance of odontoid tip above Chamberlain line, and clivus-canal angle (CCA), were collected and compared by paired t-test. Results: All 15 patients had atlas assimilation, among which 12 patients had C2-C3 fusion (Klippel-Feil syndrome). Mobilization of the HRVA was successfully completed, and C2 pedicle screws were then fulfilled after the vertebral artery was protected. There was no injury to the vertebral artery during the operation. Meanwhile, no severe surgical complications such as cerebral infarction or aggravated neurological dysfunction occurred during the perioperative period. Satisfactory C2 pedicle screw placement and reduction were reached in all 15 patients. All the patients achieved bone fusion 6 months after surgery. No looseness and shift of internal fixation or reduction loss was observed during the follow-up period. Compared to the preoperative, the postoperative JOA score and the main radiological measurements were remarkably improved and statistically significant. Conclusions: C2 pedicle screw insertion assisted by mobilization of the vertebral artery is safe and considerably effective, providing a choice for internal fixation in cases with high-riding vertebral arteries.

Vertebral Artery Variation and Imposed Risks Associated with Anterior Cervical Discectomy and Fusion Procedures - A Case Study with Surgeons' Perspectives.

Introduction: Anterior cervical discectomy and fusion (ACDF) is a common cervical procedure with more than 137,000 cases in the United States (U.S.) each year. Historically, ACDF has been a relatively safe procedure despite encountering vital anatomical structures that can risk serious complications. One particularly dangerous sequela of ACDF is the risk of lacerating the vertebral artery (VA). While VA injuries are rare (0.5% of cases), it is crucial for surgeons to prevent this potentially deadly complication with thorough knowledge of VA anatomy. The VA is commonly protected within the transverse foreman; however, anomalies can exist with the artery potentially being found more medial or proximal within the surgical site than expected. The purpose of this article is to report an anomaly found in a cadaveric specimen, where the VA courses within 2 mm of an ACDF plate. Case Report: A 66-year-old male with a past medical history of coronary artery disease passed away due to complications of a myocardial infarction. During cadaveric dissection, it was discovered that the donor had undergone a previous 3-level (C4-C7) ACDF procedure for an unknown reason. Under further examination, the left VA was observed to take an anomalous medially tracking course before eventually entering the transverse foramina of C5. Left anterior tubercles were absent at the level of C5 and C6 with prominent osteophytes found on the anterior tubercles/transverse foramina of the contralateral side. Conclusion: There are no studies published on the anatomy of VA variants and their implications on ACDF procedures. ACDF was found to have complication rates in 13.2% of cases. VA variants are observed in up to 20% of the U.S. population and VA injury in ACDF procedures has a rate near 0.5%. With anatomic variations leading to a higher risk of injury, surgeons are required to take further precautionary steps before operating including ordering computed tomography angiography or magnetic resonance angiography films. Understanding the detailed anatomy of the VA and its variants is critical. Using the perspectives of orthopedic spine surgeons, this study supplements the literature on potential VA anomalies encountered in ACDF procedures.

[Curative effect analysis of anterior cervical discectomy and fusion in patients with cervical spondylosis of vertebral artery type].

OBJECTIVE: To investigate the clinical effect of anterior cervical discectomy and fusion (ACDF) in the treatment of cervical spondylosis of vertebral artery type(CSA). METHODS: The clinical data of 42 patients with CSA from January 2020 to January 2022 were retrospectively analyzed. There were 25 males and 17 females, aged from 30 to 74 years old with an average of (53.9±11.0) years old. There were 18 cases with single-segment lesions, 17 cases with two-segment lesions, and 7 cases with three-segment lesions. The American Academy of Otolaryngology-Head and Neck Surgery's Hearing and Balance Committee score (CHE), the Neck Disability Index (NDI) and the cervical curvature Cobb angle were recorded before surgery and after surgery at 6 months. RESULTS: All 42 ACDF patients were followed up for 6 to 30 months with an average of (14.0±5.2) months. The operative time ranged from 95 to 220 min with an average of (160.38±36.77) min, the intraoperative blood loss ranged from 30 to 85 ml with an average of (53.60±18.98) ml. Tow patients had mild postoperative dysphagia, which improved with symptomatic treatment such as nebulized inhalation. CHE score decreased from (4.05±0.96) preoperatively to (2.40±0.70) at 6 months postoperatively (t=12.97, P<0.05). The number of improved vertigo at 6 months postoperatively was 38, with an improvement rate of 90.5%. NDI score was reduced from (34.43±8.04) preoperatively to (20.76±3.91) at 6 months postoperatively (t=11.83, P<0.05). The cervical curvature Cobb angle improved from (8.04±6.70)° preoperatively to (12.42±5.23)° at 6 months postoperatively (t=-15.96, P<0.05). CONCLUSION: The ACDF procedure has outstanding clinical efficacy in treating CSA. The operation can rapidly relieve patients' episodic vertigo symptoms by relieving bony compression and reconstructing cervical curvature. However, it is necessary to strictly grasp the indications for surgery and clarify the causes of vertigo in patients, and ACDF surgery is recommended for CSA patients for whom conservative treatment is ineffective.

Cervical Radiculopathy and Vertebrobasilar Insufficiency Secondary to Intraneural Foramen Vertebral Artery Loop: A Case Report.

This case report describes a 40-year-old male who presented with chronic neck pain radiating to the left upper limb, associated with weakness and numbness. He also had symptoms of vertebrobasilar insufficiency. Imaging revealed an intraneural foramen vertebral artery (VA) loop compressing the C3 nerve root. Conservative management was ineffective, prompting surgical decompression via a left C2-C3 facetectomy and foraminotomy. The patient experienced immediate pain relief and gradual improvement in weakness, with complete resolution of symptoms at the six-month follow-up. This case highlights the potential for VA loops to cause radiculopathy and the successful use of surgical decompression for treatment.

A Case of Bony Stroke Involving a Vertebral Artery Detected by Dynamic Three-dimensional Computed Tomography Angiography.

When an ischemic stroke occurs due to bone or cartilage dynamically affecting vessels supplying the brain, it is called bony stroke. We herein report a patient with recurrent cryptogenic stroke that was thought to be a bony stroke. Dynamic three-dimensional computed tomography angiography revealed mechanical compression of the vertebral artery by the hyoid bone and thyroid cartilage. The patient had a recurrent stroke during antiplatelet therapy. Surgical removal of bone tissue prevents stroke recurrence.

Exploring the atlantic part of the vertebral artery in the South Indian Population and its implications in spine surgery.

Study Design: A descriptive, quantitative cross-sectional study of the atlantic part (V3) of the vertebral artery (VA). Purpose: This study aimed to bridge the research gap in the morphometry of the V3 segment of the VA in the South Indian population. Overview of Literature: The microsurgical anatomy of this segment of the VA has been explored in various populations, and a thorough understanding of the anatomy and course of the VA, particularly the V3 segment, is essential to prevent iatrogenic complications. Several computed tomography studies but a few cadaveric studies have explored the V3 segment of the VA in the South Indian population. Methods: This study examined 40 VAs from 20 embalmed cadavers that were obtained from the voluntary donation program, and Institutional Ethical Clearance was obtained before the study. The length, diameter, and angle of the vertical, horizontal, and exit parts of the V3 segment of the VA were documented after its exposure. Results: The mean lengths of the right and left VAs on each part were nearly similar, except for the mean length of the horizontal part (right: 38.937 mm, left: 40.237 mm) and total length of the V3 segment (right: 66.870 mm, left: 70.350 mm). Conclusions: These morphometric parameters are essential to spine surgeons who intend to operate on a small part (vertical, horizontal, or exit part) of the V3 segment of the VA. The mean values of the parameters obtained in this study give average measurements or safe limits to surgeons for safe surgical procedures such as the occipital condyle screw technique and C1 laminectomy.

Extensive Lateral Cervical Desmoid Tumor Dependent on the Levator Scapulae Muscle Involving the Vertebral Artery Treated by Surgical Resection and Intraoperative Navigation: A Case Report and Review of the Literature.

Desmoid tumors are rare, benign, but locally aggressive fibromatoses that pose significant therapeutic challenges, particularly when located in the head and neck region. This report details the case of an extensive cervical desmoid tumor dependent on the levator scapulae muscle and involving the vertebral artery managed through surgical resection and intraoperative navigation. A 45-year-old male presented with a slowly growing cervical mass. Imaging revealed an 83x68x40 mm mass in the right lateral paravertebral space, dependent on the levator scapulae muscle and involving the vertebral artery. Biopsy confirmed a low-grade fusocellular myofibroblastic neoplasm consistent with a desmoid tumor. Given the poor prognosis associated with the symptomatic mass, surgical resection was performed using Brainlab intraoperative navigation (Brainlab, Munich, Germany). The procedure was successful, with preservation of vital structures and no evidence of recurrence postoperatively. Desmoid tumors in the head and neck region, though rare, require precise diagnostic and therapeutic approaches due to their aggressive nature and proximity to critical anatomical structures. The use of intraoperative navigation, in this case, facilitated accurate tumor resection, minimizing damage to surrounding tissues. Pathological analysis revealed a CTNNB1 gene mutation, specifically the S45P variant, which is associated with an increased risk of recurrence. This case highlights the importance of a multidisciplinary approach, incorporating advanced surgical techniques and genetic analysis, in the management of complex desmoid tumors. Intraoperative navigation proved invaluable in achieving successful surgical outcomes, underscoring its potential utility in similar cases. Continued follow-up is essential, given the potential for recurrence associated with desmoid tumors.

Vertebral arteria lusoria-Hyrtl's original description (1859), case illustration, and literature analysis.

PURPOSE: A translation of the initial observation of vertebral arteria lusoria reported by Hyrtl in 1859 is followed by a review of all cases published until May 2023 to identify the anatomical and clinical features characterizing the typical form of this rare variant. METHODS: PubMed, Google Scholar, and Google queries were performed with "vertebral arteria lusoria", "retroesophageal vertebral artery", and "aberrant vertebral artery" as keywords (in English, German, and French). A feature was considered typical when present in at least 75% of analyzed cases. A case of incidentally discovered vertebral arteria lusoria illustrates the typical form of the variant. RESULTS: The analysis of 56 publications yielded 66 observations of right-sided vertebral arteria lusoria published between 1859 and May 2023. A small caliber, a retro-esophageal location, and passage through the foramen transversarium of C7 were typical. There was no evidence of association with clinical symptoms or other cardiovascular anomalies. CONCLUSION: A typical vertebral arteria lusoria is an incidentally discovered nondominant aberrant right VA originating from the proximal descending aorta and following a retro-esophageal course to enter the C7 foramen transversarium, without associated aortic arch branching anomalies or congenital cardiovascular pathologies.

Single Center Experience in Surgical Treatment of Extracranial Supra-Aortic Aneurysms.

Objective To evaluate the effect of surgical treatment on extracranial supra-aortic aneurysms and summarize the experience.Methods The clinical data of 10 patients undergoing surgical treatment of extracranial supra-aortic aneurysms from May 2019 to November 2023 in the Department of Vascular Surgery of Beijing Tiantan Hospital affiliated to Capital Medical University were collected.The 10 patients included 5 patients with internal carotid artery aneurysm,2 patients with subclavian artery aneurysm,2 patients with vertebral artery aneurysm,and 1 patient with internal carotid artery aneurysm combined with ipsilateral subclavian artery aneurysm.The surgical indications,surgical regimens,clinical efficacy,and complications were retrospectively analyzed. Results All the 10 patients underwent surgery successfully,with the surgery duration range of 60-420 min and the median surgery duration of 180.0 (121.5,307.5) min.Intraoperative bleeding volume varied within 30-400 mL,with a median of 90 (50,125) mL.The time of carotid artery blocking and vertebral artery blocking varied within the ranges of 10-20 min and 20-30 min,with the medians of 15.0 (11.5,16.3) min and 25.0 (15.0,22.5) min,respectively.No cardiac accident,cerebral infarction,or cerebral hemorrhage occurred during the perioperative period.The 10 patients were followed up for 3-58 months,with the median follow-up time of 8.5 (5.3,17.0) months.One patient with subclavian artery aneurysm developed artificial vessel occlusion 20 months after surgery.One patient with internal carotid artery aneurysm developed distal carotid artery stenosis 6 months after surgery. Conclusion Surgical treatment should be actively adopted for extracranial supra-aortic aneurysms,and individualized surgical regimens should be designed according to patient conditions.

Selective postmortem arterial angiography of head and neck using digital x-ray or computed tomography: A practical and rapid method to identify vascular injuries.

Identification of vascular injuries is crucial for complete postmortem evaluation and understanding of trauma deaths by the Medical Examiner. Some vascular injuries are difficult to evaluate due to challenging anatomic locations, especially in the head and neck. Documenting injuries of the facial and vertebral arteries is challenging and necessitates time-consuming dissections that can create artifacts and disfigurement. In busy medical examiner offices with a significant number of traumatic injuries, finding a creative solution to employ reliable postmortem angiography is desirable. At the Office of the Chief Medical Examiner for the State of Maryland (OCME), we created and effectively implemented a selective angiography procedure using traditional indwelling Foley catheters and water-soluble barium swallow contrast to evaluate arterial injuries using either digital radiography or computed tomography imaging modalities. This technique and imaging interpretation can be performed by a medical examiner or forensic pathology fellow after basic technical training and basic radiology training. This study outlines the technique, methods, and utilization of the procedure and describes the findings of six deaths due to vascular lesions from different injury mechanisms and disease processes and describes the ease of implementation on a broader scale in busy Medical Examiner's offices.

Microneurosurgery for Ruptured Aneurysm of Distal Intracranial Vertebral Artery: A Case Report.

The International Subarachnoid Aneurysm Trial led to a shift from clipping to endovascular coiling as the primary therapy for cerebral aneurysm particularly in the management of posterior circulation aneurysm. However, endovascular therapy is often unavailable in low-resource settings, emphasizing the importance of maintaining surgical skill sets in resource-poor countries. This article presents a detailed case report on the successful microneurosurgical management of a 65-year-old female with a history of headache and weakness with past history of hypertension and a right posterior cerebral artery territory infarct who was diagnosed with a ruptured aneurysm situated within the intracranial vertebral artery. Patient was operated with the far lateral approach and clipping of the aneurysm. This case report elucidates the intricate surgical techniques employed, and the challenges neurosurgeons encountered in treating posterior circulation intracranial aneurysms, particularly those with ruptured complications. The aneurysms' intricate anatomy and increased rupture risk necessitate a meticulous microneurosurgical approach. The severity of subarachnoid hemorrhage from ruptured aneurysms increases morbidity and mortality rates.

Morphological Features of the Vertebrobasilar System Predict Ischemic Stroke Risk in Spontaneous Vertebral Artery Dissection.

The vertebral artery's morphological characteristics are crucial in spontaneous vertebral artery dissection (sVAD). We aimed to investigate morphologic features related to ischemic stroke (IS) and develop a novel prediction model. Out of 126 patients, 93 were finally analyzed. We constructed 3D models and morphological analyses. Patients were randomly classified into training and validation cohorts (3:1 ratio). Variables selected by LASSO - including five morphological features and five clinical characteristics - were used to develop prediction model in the training cohort. The model exhibited a high area under the curve (AUC) of 0.944 (95%CI, 0.862-0.984), with internal validation confirming its consistency (AUC = 0.818, 95%CI, 0.597-0.948). Decision curve analysis (DCA) indicated clinical usefulness. Morphological features significantly contribute to risk stratification in sVAD patients. Our novel developed model, combining interdisciplinary parameters, is clinically useful for predicting IS risk. Further validation and in-depth research into the hemodynamics related to sVAD are necessary.

A combined endovascular and open repair of innominate artery bifurcation pseudoaneurysm: a case report.

BACKGROUND: Innominate artery aneurysms (IAAs) are rare and may result in rupture, distal arterial embolization, or local compression without timely treatment. Rupture is the most dangerous of these complications. This article reports a case of innominate artery bifurcation pseudoaneurysm. CASE PRESENTATION: The patient was a 45-year-old man who was admitted to the emergency department due to chest discomfort. The computed tomographic angiography (CTA) imaging indicated the presence of a 3.6*2.4 cm saccular aneurysm in the bifurcation of the innominate artery, involving both the right proximal subclavian and common carotid arteries. The patient's vital signs were normal, there was equal blood pressure in the upper arms and no neurological dysfunction was observed. Gadolinium-enhanced magnetic resonance angiography indicated that the circle of Willis was intact. The treatment involved open surgery combined with endovascular therapy. The external carotid artery was first transposed to the right subclavian artery (RSA) and an 8-mm woven Dacron graft was inserted in the middle. The covered stent graft was then placed in the proximal part of the innominate artery to close the entrance of the aneurysm. Lastly, an occluder was implanted at the origin of the RSA. There were no perioperative or postoperative complications. At 1-year follow-up, no aneurysm was observed on CTA and the right vertebral artery was patent. CONCLUSIONS: This study indicated that the combined use of endovascular therapy and open repair surgery is an effective strategy to treat innominate artery bifurcation pseudoaneurysm.

Soft Tissue Dissection in the Transcondylar Approach: A Modified Layered Technique to Maximize Lateral Access.

Objective While the transcondylar approach is technically challenging, it provides generous ventral and caudal exposure to the craniovertebral junction. This approach requires navigation around multiple eloquent neurovascular structures including the lower cranial nerves, vertebral artery and its branches, and the brainstem. Superficial exposure, including incision location and muscle dissection, can dramatically affect the surgical angle and maneuverability at depth. Methods We demonstrate the transcondylar approach in a step-by-step fashion in a formalin-embalmed, latex-injected cadaver head. Dissection within each layer of the suboccipital muscles was performed. A small cohort with an illustrative case is also included herein. Results The sternocleidomastoid (SCM) muscle was retracted anteriorly; the splenium capitis, semispinalis capitis, and longissimus capitis muscles were disconnected from the superior nuchal line and reflected inferomedially. The suboccipital muscle group was fully exposed. The superior and inferior oblique muscles were disconnected from the transverse process of C1. The superior oblique and the rectus capitis posterior major muscles were then dissected off the inferior nuchal line, and the suboccipital muscle group was retracted inferomedially en bloc . The greater auricular nerve was retracted laterally with the SCM, and the greater occipital nerve was retracted inferomedially with the suboccipital muscle group. Conclusion This technique avoids the obstructive muscle bulk that results from a myocutaneous approach while maximizing deep exposure. Understanding the detailed muscular anatomical relationship with the insertion location and suboccipital nerves is key to complete and safe extracranial dissection. Diligent dissection helps minimize postoperative pain and muscle spasm while optimizing the closure technique.

Acute morphological changes of impending rupture of vertebral artery dissection: clinical management of symptomatic but unruptured vertebral artery dissection. Illustrative case.

BACKGROUND: The reported actual risk of rupture for vertebral artery dissection (VAD) in patients presenting with headache is very low, ranging from 0.4% to 1.0%. The authors report a case in which the dissection site dilated rapidly within several hours after the dissection occurred resulting in subarachnoid hemorrhage (SAH). OBSERVATIONS: A 49-year-old healthy man who had participated in a marathon noticed a headache while running. Magnetic resonance imaging (MRI) performed 2 days later revealed no findings suspicious for right VAD, but a string sign was observed in the left side, suggesting left VAD. Three hours following MRI, he developed severe headaches and became unconscious at home, prompting emergency services to rush him to the hospital. A computed tomography scan showed diffuse SAH and a rapidly enlarged aneurysmal dilatation in the right vertebral artery. He underwent endovascular internal trapping to prevent rebleeding. He was discharged without any neurological symptoms. No recurrence or new dissection occurred after 2 years of follow-up. LESSONS: Even in the absence of typical imaging findings, strict management, such as blood pressure control, is required when clinical findings strongly suggest VAD, and differentiation of VAD from primary headache is important. https://thejns.org/doi/10.3171/CASE24202.

Treatment of medullary aneurysm in the collateral circulation with a flow diverter: A case report.

INTRODUCTION AND IMPORTANCE: Spinal aneurysms rarely occur in the collateral circulation of the vertebral artery (VA). These aneurysms are difficult to treat. A flow diverter (FD) can be a therapeutic option. CASE PRESENTATION: A 62-year-old man suffered subarachnoid hemorrhage. His Hunt-Hess scale classification was grade II. Digital subtraction angiography (DSA) revealed that the bilateral distal VAs were occluded, there were two flow-related aneurysms in the collateral circulation of the first radicular artery of the VA, and there was a dissecting aneurysm at the origin of the posterior inferior cerebellar artery (PICA). The FD covered the PICA dissecting aneurysm, and the first radicular artery originated in the VA. Postoperatively, computed tomography angiography revealed a patent PICA and regression of the aneurysm in the collateral circulation. At the one-month follow-up, he showed good recovery and was therefore allowed to return to work. Follow-up DSA confirmed the regression of the aneurysms. However, the intracranial VA and PICA were unexpectedly occluded. CLINICAL DISCUSSION: It is difficult to catheterize aneurysms in the collateral circulation to perform coiling. It is also dangerous to embolize such aneurysms with a liquid embolic agent. After FD deployment to cover the origin of the parent artery, the hemodynamic stress of the aneurysm decreases, and the aneurysm can regress. CONCLUSION: Aneurysms in the collateral circulation were not accessible. FD deployment in the parent artery to cover the origin of the feeding artery of the collateral circulation is feasible for treating such aneurysms.

Vertebral artery injury following combination Jefferson fracture of C1 and Type II odontoid fracture: A case report.

Traumatic posterior atlantoaxial dislocation combined with Jefferson fracture and odontoid process fracture with vertebral artery injury is rare. The management of such injury raises controversial issues and is still open to debate. A 74-year-old Chinese male presented with sustained neck pain and stiffness after falling from height. The patient was neurologically intact. Preoperative radiographs demonstrated a Jefferson burst fracture with a posterior dislocation of the atlantoaxial joints and odontoid process Anderson and D'alonzo type II fracture. A computed tomography angiography (CTA) showed an occluded left vertebral artery. Coil embolization in the proximal portion of the occluded vertebral artery was performed to prevent further cerebral infarction due to distal embolization of the thrombus. Then a second stage occipito-cervical fusion was performed to reconstruct cervical spine stability. A systematic screening of blunt trauma vertebral artery injuries through CTA is required when dealing with upper cervical fracture. For cases with vertebral artery occlusion secondary to cervical spine injury, endovascular treatment preceding cervical spine surgery is a feasible and a safe treatment.

Does ponticulus posticus affect vertebral artery diameter.

PURPOSE: Ponticulus Posticus, atlantooccipital ligament ossification-induced anomaly, surrounds the vertebral artery and the first cervical nerve root. It is believed to wrap around the first cervical nerve root and the vertebral artery, causing compression. We hypothesized that it would also reduce the diameter of the vertebral artery. METHODS: Between January 1, 2022, and December 31, 2022, cervical spine CT scans taken for any reason were retrospectively reviewed. The images of 1365 patients suitable for evaluation were evaluated by two expert radiologists in 3 dimensions. Among patients with PP, those who underwent cervical angiography were identified for vertebral artery diameter measurement. RESULTS: The average age of the 1365 individuals included in the study (732 males, 633 females) was 55.78 (± 18.85) with an age range of 1-96. Among this group, PP was detected in 288 individuals, resulting in a total prevalence of 21.1%. Right and left vertebral artery diameters were significantly lower in patients with complete PP compared to the absent group (p < 0,001, p < 0,001, respectively). Additionally, it was observed that width and height diameters and artery diameters were positively correlated in patients with Complete PP. CONCLUSIONS: Ponticulus posticus can cause vertebrobasilar insufficiency by reducing the diameter of the vertebral artery. Therefore, imaging and detailed evaluation of this region are important in symptomatic patients.

Percutaneous Transluminal Angioplasty for Atherosclerotic Stenosis of Vertebral Artery Origin.

Background: In patients with vertebral artery origin (VAO) stenosis and concomitant stenoses of other cerebral feeding arteries, data on the risk of percutaneous transluminal angioplasty (PTA) alone and with stent placement (PTAS) for VAO stenosis are limited. We aimed to determine how the presence of polystenotic lesions in other cerebral feeding arteries and concomitant carotid artery stenting (CAS) affect the periprocedural risk and long-term effect of PTA/S for atherosclerotic VAO stenosis. Methods: In a retrospective descriptive study, consecutive patients treated with PTA/S for ≥70% VAO stenosis were divided into groups with isolated VAO stenosis and multiple stenoses. We investigated the rate of periprocedural complications in the first 72 h and the risk of restenosis and ischemic stroke (IS)/transient ischemic attack (TIA) during the follow-up period. Results: In a set of 66 patients aged 66.1 ± 9.1 years, polystenotic lesions were present in 56 (84.8%) patients. 21 (31.8%) patients underwent endovascular treatment for stenosis of one or more other arteries in addition to VAO stenosis (15 underwent CAS). During the periprocedural period, no patient suffered from an IS or died, and, in the polystenotic group with concomitant CAS, there was one case of TIA (1.6%). During a mean follow-up period of 36 months, we identified 8 cases (16.3%) of ≥50% asymptomatic VA restenosis, and, in the polystenotic group, 4 (8.9%) cases of IS. Conclusion: The presence of severe polystenotic lesions or concomitant CAS had no adverse effect on the overall low periprocedural risk of PTA/S of VAO stenosis or the risk of restenosis during the follow-up period.