J Korean Neurosurg Soc.  2022 Jul;65(4):603-608. 10.3340/jkns.2021.0222.

Extracranial Carotid-Vertebral Artery Bypass Technique and Surgical Outcomes

• Lee JK
• Park IS

• KMID: 2531630
• DOI: http://doi.org/10.3340/jkns.2021.0222

Abstract

Vertebral artery (VA) occlusion is frequently encountered, usually without acute ischemic injury of the brain. However, when it is accompanied by hypoplasia or stenosis of the opposite VA, brain ischemia may develop due to insufficient collateral supply. Both hemodynamic instability and embolic infarction can occur in VA occlusion, which may cause severe symptoms in a patient. Extracranial carotid-VA bypass should be considered for symptomatic VA occlusion patients, especially when the patient has repeated ischemic brain injuries. In this report, the cases of three extracranial carotid-VA bypass patients are introduced, along with a brief description of the surgical techniques. All three cases were treated with different bypass methods according to their disease location.

Keyword

Vertebrobasilar insufficiency; Vertebral artery; Arterial bypass; Extracranial intracranial

Figure

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  Fig. 1. A : Images of diffusion-weighted brain magnetic resonance imaging show multiple infarctions in the right cerebellum and the left occipital lobe (white arrows). B : Digital subtraction angiogram of left vertebral artery revealed an occlusion of vertebral artery origin (white arrow) and retrograde filling of vertebral artery (V2 segment, asterisk) through cervical muscular branch of subclavian artery (black arrow).

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  Fig. 2. A : Postoperative computerized tomography angiography volume rendering image after surgery show transposition of the proximal vertebral artery (white arrow) to the common carotid artery (white asterisk) with clipping of proximal vertebral artery origin (white arrowhead). B : Post operative digital subtraction angiogram with 3 dimensional reconstruction image show end to side bypass of vertebral artery to common carotid artery with good patency.

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  Fig. 3. A : Magnetic resonance angiogram reveal right common carotid artery occlusion (white asterisk) with left proximal internal carotid artery (white arrow) and 4th segment of right vertebral artery stenosis. B : Time-to-peak image of the perfusion magnetic resonance imaging show hemodynamic insufficiency in the right hemisphere.

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  Fig. 4. A : Postoperative computerized tomography angiography volume rendering image after bypass surgery show right common carotid artery (arrow) is connected with right vertebral artery (arrowhead) by the graft vessel (asterisk). B : Postoperative digital subtraction angiography with right vertebral artery (arrowhead) selection show blood flow from the vertebral artery to the anterior circulation via common carotid artery. C : Postoperative time-to-peak image of perfusion magnetic resonance display hemodynamic improvements on right hemisphere (asterisk).

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  Fig. 5. A : Image of diffusion-weighted brain magnetic resonance imaging shows infarction in the right cerebellum (white arrow). B : Magnetic resonance angiogram revealed right vertebral artery hypoplasia (arrows) with left proximal vertebral artery occlusion (asterisk). C : Perfusion magnetic resonance imaging shows time-to-peak prolongation on the right posterior cerebral artery territory (white arrows).

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  Fig. 6. Postoperative computerized tomography angiography volume rendering image show bypass from external carotid artery (arrow) to the left vertebral artery (asterisk) using the saphenous vein graft (arrowhead).

Reference

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