Fourteen patients were selected to have a total of 15 vertebral artery reconstructions in a four-year period. They all had incapacitating neurologic symptoms, and detailed investigations had been done to rule out other possible causes. If more than one lesion was present in the angiogram, priority was given to the reconstruction of carotid lesions. If symptoms persisted, vertebral artery stenoses were considered significant only if they involved greater than or equal to 75% of the cross-sectional area with the other vertebral artery being equally diseased or absent. The preferred operation was a vertebral artery bypass, although four reimplantations were done. Postoperative angiograms showed all grafts to be patent. Patency was confirmed again at 28 +/- 16 SD months by Doppler imaging. There were no operative neurologic deficits or deaths. All patients but one (in whom the selection protocol was not followed strictly) were relieved of their incapacitating symptoms.