Vertebral Artery to Middle Cerebral Artery Bypass for Flow Augmentation
Related Experiment Video
Updated: Jul 12, 2025
Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment
Published on: September 25, 2009
Richard Bram1, Zayed Almadidy1, John Souter1
1Department of Neurosurgery, University of Illinois at Chicago, Chicago , Illinois , USA.
Insights
Vertebral artery to middle cerebral artery bypass using a radial artery graft is a viable alternative revascularization strategy for cerebrovascular steno-occlusive disease when superficial temporal artery donors are unsuitable.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Cerebrovascular Disease
Background:
- Extracranial-intracranial bypass is crucial for steno-occlusive cerebrovascular disease.
- Superficial temporal artery (STA) to middle cerebral artery (MCA) bypass is common but not always feasible.
- Alternative revascularization strategies are necessary when STA donors are unavailable.
Background And Importance:
Extracranial-intracranial bypass remains an enduring procedure for a select group of patients suffering from steno-occlusive cerebrovascular disease. Although the superficial temporal artery (STA) to middle cerebral artery (MCA) bypass is most familiar among neurosurgeons, particular circumstances preclude the use of an STA donor. In such cases, alternative revascularization strategies must be pursued.
Clinical Presentation:
A 63-year-old female presented with symptoms of hemodynamic insufficiency and was found to have left common carotid artery occlusion at the origin. She experienced progressive watershed ischemia and pressure-dependent fluctuations in her neurological examination despite maximum medical therapy. The ipsilateral STA was unsuitable for use as a donor vessel. We performed an extracranial vertebral artery (VA) to MCA bypass with a radial artery interposition graft.
Conclusion:
This technical case description and accompanying surgical video review the relevant anatomy and surgical technique for a VA-MCA bypass. The patient was ultimately discharged home at her preoperative neurological baseline with patency of the bypass. The VA can serve as a useful donor vessel for cerebral revascularization procedures in pathologies ranging from malignancies of the head and neck to cerebral aneurysms and cerebrovascular steno-occlusive disease.
