Cerebral bypass for symptomatic vertebrobasilar dolichoectasia

The standard therapeutic strategies for vertebrobasilar dolichoectasia (VBD) are controversial due to their complexity, high risks and great complications. The current study is conducted to describe the use of cerebral bypass to treat symptomatic VBD. This retrospective study from 2019 to 2024 involved 20 patients who underwent cerebral bypass to treat symptomatic VBD. Cerebral ischemia and compression were the main presentations of patients with VBD. Dissecting, partially thrombosed and incorporate important perforating arteries were the morphological characteristics of VBD. Among the entire cohort, fourteen patients accepted the high-flow bypass and six patients underwent low-flow bypass. Clinical improvement occurred in 16 of the 20 patients, but decrease in 4 patients due to cerebral infarction or hematoma postoperatively. One patient died after the operation because of cerebral infarction. The mean follow-up period was 37 months, and during the follow-up period, all bypasses were patent, and no new deaths could be found. Treatment of complex VBD is challenging, base on a more precise preoperative assessment, cerebral bypass may be an effective treatment for complex VBD that does not respond to conservative management or other intervention options.