Vertebral artery surgery with cardiopulmonary bypass and deep hypothermia

Deep hypothermia was proposed to prevent neuronal ischemia and stroke during surgical procedures on arteries that supply the brain, especially with extended occlusive lesions on both internal carotid arteries. The interest of this therapeutic option is still under discussion, even in the case of combined cardiac and cerebrovascular surgery. We report the case of a 53-year-old male who was admitted to our institution for symptomatic vertebrobasilar insufficiency. Angiography showed a thrombosis of both internal carotid arteries, stenosis of both external carotid arteries, and a tight proximal stenosis of a dominant right vertebral artery. Endarterectomy and angioplasty of the origin of the right external carotid artery was done first to increase the blood supply to the brain via collateral arteries connecting the extra- and intracranial networks. Six weeks after this, a right-sided vertebral-to-carotid artery anastomosis was performed during cardiopulmonary bypass (CPB)-induced deep hypothermia for optimal neuronal protection, with good results. However, early thrombosis of the right vertebral artery requiring reintervention in normothermia, without any stroke, indicate that deep hypothermia was unnecessary in this case, probably because of the previous natural and surgical development of collateral circulation. However, there was no means of predicting this in a reliable manner before the procedure and deep hypothermia appeared a safe technique for neuronal protection without any specific postoperative complications.