Aim -to develop the method of surgical treatment of V1 and V2 segments occlusions or stenoses of vertebral arteries combined with V4 segment stenoses of vertebral arteries and basilar artery. Material and methods. A hybrid method was used in 4 patients with symptoms of vertebral-basilar insufficiency who had a combination of subtotal stenosis or occlusion of V1 and V2 segments of vertebral artery (extracranial lesion) with stenosis of V4 segment of vertebral artery and basilar artery (intracranial lesion). Results. Grafts and stents were patent in all patients during follow-up. There were no signs of restenoses. Volumetric flow rate through the graft exceeded 100 mL/min in all patients. Dynamic neurological examination showed persistent clinical improvement with reduction or disappearance of coordination and statics disorders, auditory and visual disturbances in all patients.
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