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J Neurol Surg A Cent Eur Neurosurg 2025; 86(01): 099-104
DOI: 10.1055/s-0043-1775989
Technical Note

Alternative Bypass Technique Using Radial Artery Graft between V3 Segment of Vertebral Artery and Middle Cerebral Artery: Technical Note

Yasuhiro Ito
1   Department of Neurosurgery, Kashiwaba Neurosurgical Hospital, Hokkaido, Japan
,
Katsuhiko Maruichi
1   Department of Neurosurgery, Kashiwaba Neurosurgical Hospital, Hokkaido, Japan
,
Naoki Nakayama
1   Department of Neurosurgery, Kashiwaba Neurosurgical Hospital, Hokkaido, Japan
,
Hiroyuki Kobayashi
1   Department of Neurosurgery, Kashiwaba Neurosurgical Hospital, Hokkaido, Japan
,
Ryota Tatezawa
1   Department of Neurosurgery, Kashiwaba Neurosurgical Hospital, Hokkaido, Japan
,
Shinitirou Shinada
1   Department of Neurosurgery, Kashiwaba Neurosurgical Hospital, Hokkaido, Japan
,
Shunsuke Terasaka
1   Department of Neurosurgery, Kashiwaba Neurosurgical Hospital, Hokkaido, Japan
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Abstract

Background There are some cases where a radial artery (RA) graft is needed for a high-flow extracranial to intracranial (EC-IC) bypass as the external carotid artery (ECA) cannot be utilized as a donor artery. In this report, we describe two cases of extracranial vertebral artery (VA) to middle cerebral artery (MCA) high-flow bypass using an RA graft with an artificial vessel as an alternative bypass technique.

Methods The patient was placed supine with a head rotation of 80 degrees. After frontotemporal craniotomy, another C-shaped skin incision was made at the retroauricular region and the V3 portion of the VA was exposed at the suboccipital triangle. Prior to attempting the high-flow bypass, the superficial temporal artery (STA) was anastomosed to the M4 portion of the MCA as an insurance bypass. The RA graft was anastomosed to the V3 portion of the VA that traveled under the periosteum at the supra-auricular region through an artificial vessel. After RA-M2 anastomosis, an alternative EC-IC bypass, the V3-RA-M2 bypass, was achieved.

Results Postoperative angiography demonstrated successful graft patency and no perioperative complications were observed in both cases.

Conclusions In the cases where a high-flow bypass is required, the V3 portion of the VA is a suitable alternative proximal anastomosis site when the ECA is not a candidate donor. Furthermore, an artificial vessel shows satisfactory protection against graft complications.

Keywords

artificial vessel - high-flow bypass - radial artery graft - surgical technique - vertebral artery


Publication History

Received: 26 July 2022

Accepted: 28 October 2022

Article published online:
13 October 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Georgieva VB, Krastev ED, Byulbyuleva SK. Extracranial-intracranial high-flow bypass for giant ruptured paraclinoid aneurysm with concomitant bilateral internal carotid artery stenotic dissection. World Neurosurg 2018; 117: 265-270
    CrossrefPubMedSearch in Google Scholar
  • 2 Chen J, Zhang C, Li P, Chen L, Wang Y. High-flow extracranial-intracranial bypass for giant cavernous carotid aneurysm. J Craniofac Surg 2018; 29 (04) 1042-1046
    CrossrefPubMedSearch in Google Scholar
  • 3 Wanibuchi M, Akiyama Y, Mikami T. et al. Radical removal of recurrent malignant meningeal tumors of the cavernous sinus in combination with high-flow bypass. World Neurosurg 2015; 83 (04) 424-430
    CrossrefPubMedSearch in Google Scholar
  • 4 Kazumata K, Nakayama N, Nakamura T, Kamiyama H, Terasaka S, Houkin K. Changing treatment strategy from clipping to radial artery graft bypass and parent artery sacrifice in patients with ruptured blister-like internal carotid artery aneurysms. Neurosurgery 2014; 10 (Suppl. 01) 66-72 , discussion 73
    PubMedSearch in Google Scholar
  • 5 Kamijo K, Matsui T. Acute extracranial-intracranial bypass using a radial artery graft along with trapping of a ruptured blood blister–like aneurysm of the internal carotid artery. Clinical article. J Neurosurg 2010; 113 (04) 781-785
    CrossrefPubMedSearch in Google Scholar
  • 6 Diaz FG, Pearce J, Ausman JI. Complications of cerebral revascularization with autogenous vein grafts. Neurosurgery 1985; 17 (02) 271-276
    CrossrefPubMedSearch in Google Scholar
  • 7 Kinugasa K, Sakurai M, Ohmoto T. Contralateral external carotid-to-middle cerebral artery graft using the saphenous vein. Case report. J Neurosurg 1993; 78 (02) 290-293
    CrossrefPubMedSearch in Google Scholar
  • 8 Sekhar LN, Bucur SD, Bank WO, Wright DC. Venous and arterial bypass grafts for difficult tumors, aneurysms, and occlusive vascular lesions: evolution of surgical treatment and improved graft results. Neurosurgery 1999; 44 (06) 1207-1223 , discussion 1223–1224
    PubMedSearch in Google Scholar
  • 9 Yang T, Tariq F, Chabot J, Madhok R, Sekhar LN. Cerebral revascularization for difficult skull base tumors: a contemporary series of 18 patients. World Neurosurg 2014; 82 (05) 660-671
    CrossrefPubMedSearch in Google Scholar
  • 10 Houkin K, Kamiyama H, Kuroda S, Ishikawa T, Takahashi A, Abe H. Long-term patency of radial artery graft bypass for reconstruction of the internal carotid artery. Technical note. J Neurosurg 1999; 90 (04) 786-790
    CrossrefPubMedSearch in Google Scholar
  • 11 Ambekar S, Madhugiri V, Sharma M, Cuellar H, Nanda A. Evolution of management strategies for cavernous carotid aneurysms: a review. World Neurosurg 2014; 82 (06) 1077-1085
    CrossrefPubMedSearch in Google Scholar
  • 12 Menon G, Menon S, Hegde A. Does universal bypass before carotid artery occlusion obviate the need for balloon test occlusion: personal experience with extracranial-intracranial bypass in 23 patients. J Neurosci Rural Pract 2019; 10 (02) 194-200
    Thieme ConnectPubMedSearch in Google Scholar
  • 13 Sorteberg A, Bakke SJ, Boysen M, Sorteberg W. Angiographic balloon test occlusion and therapeutic sacrifice of major arteries to the brain. Neurosurgery 2008; 63 (04) 651-660 , 660–661
    CrossrefPubMedSearch in Google Scholar
  • 14 Matsukawa H, Tanikawa R, Kamiyama H. et al. Risk factors for low-flow related ischemic complications and neurologic worsening in patients with complex internal carotid artery aneurysm treated by extracranial to intracranial high-flow bypass. World Neurosurg 2016; 85: 49-55
    CrossrefPubMedSearch in Google Scholar
  • 15 Miele VJ, Rosen CL, Carpenter J, Rai A, Bailes JE. Vertebral artery-to-middle cerebral artery bypass with coil embolization of giant internal carotid artery aneurysm: technical case report. Neurosurgery 2005; 56 (05) E1159 , discussion E1159
    PubMedSearch in Google Scholar
  • 16 Suarez Nieto C, Estevan Solano JM, Buron Martinez C, Fuente Martin E, Mendez Colunga JC, Abril Garcia A. The carotid artery in head and neck oncology. Clin Otolaryngol Allied Sci 1980; 5 (06) 403-417
    CrossrefPubMedSearch in Google Scholar
  • 17 Liu J, Zeng Q, Huang JJ, Hu GH. Management of infected carotid artery rupture. Eur Arch Otorhinolaryngol 2014; 271 (06) 1723-1728
    CrossrefPubMedSearch in Google Scholar
  • 18 Sanders EM, Davis KR, Whelan CS, Deckers PJ. Threatened carotid artery rupture: a complication of radical neck surgery. J Surg Oncol 1986; 33 (03) 190-193
    CrossrefPubMedSearch in Google Scholar
  • 19 Hecht N, Wessels L, Fekonja L, von Weitzel-Mudersbach P, Vajkoczy P. Bypass strategies for common carotid artery occlusion. Acta Neurochir (Wien) 2019; 161 (10) 1993-2002
    CrossrefPubMedSearch in Google Scholar
  • 20 Schneider UC, von Weitzel-Mudersbach P, Hoffmann KT, Vajkoczy P. Extracranial posterior communicating artery bypass for revascularization of patients with common carotid artery occlusion. Neurosurgery 2010; 67 (06) 1783-1789 , discussion 1789
    CrossrefPubMedSearch in Google Scholar
  • 21 Kazumata K, Asaoka K, Yokoyama Y, Sugiyama T, Kaneko S, Itamoto K. “Isolated carotid bifurcation” and vertebral-carotid artery bypass for common carotid artery occlusion. Neurol Med Chir (Tokyo) 2013; 53 (03) 179-182
    CrossrefPubMedSearch in Google Scholar
  • 22 Klonaris C, Kouvelos GN, Kafeza M, Koutsoumpelis A, Katsargyris A, Tsigris C. Common carotid artery occlusion treatment: revealing a gap in the current guidelines. Eur J Vasc Endovasc Surg 2013; 46 (03) 291-298
    CrossrefPubMedSearch in Google Scholar
  • 23 Ateş O, Ahmed AS, Niemann D, Başkaya MK. The occipital artery for posterior circulation bypass: microsurgical anatomy. Neurosurg Focus 2008; 24 (02) E9
    CrossrefPubMedSearch in Google Scholar
  • 24 Kamiyama H. Bypass with radial artery graft. No Shinkei Geka 1994; 22 (10) 911-924
    PubMedSearch in Google Scholar
  • 25 Hadeishi H, Yasui N, Okamoto Y. Extracranial-intracranial high-flow bypass using the radial artery between the vertebral and middle cerebral arteries. Technical note. J Neurosurg 1996; 85 (05) 976-979
    CrossrefPubMedSearch in Google Scholar
  • 26 Benet A, Lawton MT. V3 vertebral artery to M2 middle cerebral artery bypass: 3-dimensional operative video. Oper Neurosurg (Hagerstown) 2016; 12 (02) 194
    CrossrefPubMedSearch in Google Scholar
  • 27 Meybodi AT, Benet A, Lawton MT. The V3 segment of the vertebral artery as a robust donor for intracranial-to-intracranial interpositional bypasses: technique and application in 5 patients. J Neurosurg 2018; 129 (03) 691-701
    CrossrefPubMedSearch in Google Scholar
  • 28 Matsukawa H, Tanikawa R, Kamiyama H. et al. Graft occlusion and graft size changes in complex internal carotid artery aneurysm treated by extracranial to intracranial bypass using high-flow grafts with therapeutic internal carotid artery occlusion. Neurosurgery 2017; 81 (04) 672-679
    CrossrefPubMedSearch in Google Scholar
  • 29 Yang T, Tariq F, Duong HT, Sekhar LN. Bypass using V2-V3 segment of the vertebral artery as donor or recipient: technical nuances and results. World Neurosurg 2014; 82 (06) 1164-1170
    CrossrefPubMedSearch in Google Scholar
  • 30 Schievink WI. Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med 2001; 344 (12) 898-906
    CrossrefPubMedSearch in Google Scholar