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High-Flow Bypass with Vertebral Artery (V3) to Middle Cerebral Artery (M2) Bypass Using Radial Artery Graft for
Jae Seong Hong1, Jiwook Ryu2, Ju In Park1
1Department of Neurosurgery, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea.
Insights
High-flow vertebral artery (VA) to middle cerebral artery (MCA) bypass using a radial artery (RA) graft successfully treated a patient with common carotid artery (CCA) occlusion. This salvage technique prevented recurrent ischemic events, demonstrating its effectiveness.
Area of Science:
- Neurology
- Vascular Surgery
- Neurosurgery
Background:
- Common carotid artery (CCA) occlusion is a rare condition causing neurological deficits due to reduced cerebral blood flow.
- Symptomatic CCA occlusion requires effective revascularization strategies to prevent ischemic events.
Purpose of the Study:
- To present a case of common carotid artery (CCA) occlusion treated with a high-flow vertebral artery (VA) to middle cerebral artery (MCA) bypass using a radial artery (RA) graft.
- To highlight surgical considerations for this salvage bypass technique.
Main Methods:
- A 68-year-old male patient with recurrent ischemic events underwent a vertebral artery (V3 segment) to radial artery to middle cerebral artery (M2 segment) bypass.
- Preoperative imaging included diffusion-weighted imaging and single-photon emission computed tomography; digital subtraction angiography confirmed CCA occlusion.
Main Results:
- The vertebral artery-radial artery-middle cerebral artery bypass procedure was technically successful with an uneventful postoperative course.
- Follow-up angiography confirmed the radial artery graft's patency.
- The patient remained free of recurrent ischemic events for 2 years post-surgery.
Conclusions:
- High-flow VA-RA-MCA bypass is a viable salvage option for symptomatic common carotid artery (CCA) occlusion.
- This technique can restore adequate cerebral perfusion and prevent further ischemic events.
- Careful surgical planning and execution are crucial for successful outcomes in complex revascularization procedures.
Abstract:
Common carotid artery (CCA) occlusion is a rare condition that can result in diverse neurological symptoms due to insufficient cerebral blood flow. We present a case of CCA occlusion treated with high-flow vertebral artery (VA) to middle cerebral artery (MCA) bypass using a radial artery (RA) graft. A 68-year-old man experienced recurrent ischemic events in the months preceding surgery. Preoperative diffusion-weighted imaging showed left anterior border zone infarction, and single-photon emission computed tomography revealed severe hemispheric hypoperfusion. Digital subtraction angiography confirmed complete occlusion of the left CCA with inadequate external carotid artery supply. A VA (V3 segment)-RA-MCA (M2 segment) bypass was performed, resulting in an uneventful postoperative course. Follow-up angiography demonstrated durable patency of the radial artery graft. No recurrent ischemic events were observed during the 2-year follow-up period. This technical note demonstrates key surgical considerations for VA-RA-MCA high-flow bypass as a salvage technique in a patient with symptomatic CCA occlusion.
