scholarly journals Surgical removal using V3-radial artery graft-V4 bypass and occipital artery-posterior inferior cerebellar artery bypass for a giant thrombosed aneurysm of vertebral artery compressing brain stem: Case report

2019 ◽  
Vol 10 ◽  
pp. 220
Author(s):  
Sho Tsunoda ◽  
Tomohiro Inoue ◽  
Kazuaki Naemura ◽  
Atsuya Akabane
Keyword(s):  
Blood Flow ◽  
Vertebral Artery ◽  
Brain Stem ◽  
Radial Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Occipital Artery ◽  
Radial Artery Graft ◽  
Muscle Testing ◽  
Artery Graft ◽  
Cerebellar Artery

Background: Giant thrombosed vertebral artery aneurysms (GTVAs) are difficult disease to treat. Here, we are reporting a case of GTVA successfully treated with excluding the pathological segment and restoring the anterograde blood flow of the parent artery, highlighting the reliable surgical procedure. Case Description: A 55-year-old man with a left GTVA complained of right hemiparesis (manual muscle testing 4/5) represented by hand clumsiness and gait disturbance, in addition to severe left-sided dysesthesia, was referred to our hospital. The posterior inferior cerebellar artery (PICA) was incorporated into the GTVA segment, and the contralateral vertebral artery showed atherosclerotic change. Thus, we decided to treat the aneurysm with aneurysm trapping and thrombectomy, in conjunction with V3-radial artery graft (RAG)-V4 bypass and occipital artery (OA)-PICA bypass through a suboccipital transcondylar approach. The distal end of the dilated segment was meandering and deflecting outwardly to the vicinity of the internal auditory canal and was stretched in an axial direction. Thus, the V4 stump can be transposed to the triangle space made by the medulla, lower cranial nerves, and sigmoid sinus, and we could perform a safe and reliable anastomosis through the corridor. After the surgery, the compression of the brain stem was released, and right hemiparesis was improved completely after rehabilitation. The patient was discharged with a modified Rankin Scale score of 1. Conclusion: Trapping of the aneurysm and thrombectomy are the most radical treatment for GTVA, and if possible, reconstruction of anterograde blood flow with V3-RAG-V4 bypass and OA-PICA bypass is desirable.

Vertebral artery–posterior inferior cerebellar artery bypass using a radial artery graft for hemorrhagic dissecting vertebral artery aneurysms: surgical technique and report of 2 cases

2011 ◽  
Vol 114 (4) ◽  
pp. 1074-1079 ◽  
Author(s):  
Marcus Czabanka ◽  
Muhammad Ali ◽  
Peter Schmiedek ◽  
Peter Vajkoczy ◽  
Michael T. Lawton
Keyword(s):  
Vertebral Artery ◽  
Radial Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Occipital Artery ◽  
Radial Artery Graft ◽  
Interposition Graft ◽  
Endovascular Occlusion ◽  
Artery Graft ◽  
Cerebellar Artery ◽  
Far Lateral Approach

Endovascular occlusion of hemorrhagic dissecting aneurysms of the vertebral artery (VA) is not possible when the posterior inferior cerebellar artery (PICA) originates from the dissecting aneurysm or when the contralateral VA provides inadequate collateral blood flow to the distal basilar circulation. The authors introduce a VA-PICA bypass with radial artery interposition graft and aneurysm trapping as an alternative approach and describe 2 cases in which this bypass was used to treat hemorrhagic dissecting VA aneurysms. The VA-PICA bypass is performed via a standard far lateral approach. An end-to-side anastomosis between the radial artery graft and the PICA at the level of the caudal loop is performed first, and an end-to-side anastomosis is performed between the V3 segment and the proximal end of the radial artery graft. A 56-year-old woman harbored a hemorrhagic dissecting VA aneurysm incorporating the origin of the PICA. Endovascular treatment failed, with aneurysm refilling on follow-up angiography. A 65-year-old man had a hemorrhagic dissecting VA aneurysm and a hypoplastic contralateral VA. Both patients were treated with the VA-PICA bypass and aneurysm trapping, with adequate filling of the PICA territory in the first patient and both the PICA territory and the basilar circulation in the second patient. Vertebral artery–PICA bypass with radial artery interposition graft and subsequent trapping of the dissected VA segment is an alternative to occipital artery–PICA and PICA-PICA bypass for the treatment of hemorrhagic dissecting VA aneurysms that are not suitable for endovascular occlusion.

Vertebral Artery Disease

Neurosurgery ◽  
1981 ◽  
Vol 9 (5) ◽  
pp. 524-530 ◽  
Author(s):  
Michael B. Pritz ◽  
William F. Chandler ◽  
Glenn W. Kindt
Keyword(s):  
Carotid Artery ◽  
Vertebral Artery ◽  
Medical Management ◽  
Posterior Inferior Cerebellar Artery ◽  
External Carotid Artery ◽  
The Other ◽  
External Carotid ◽  
Occipital Artery ◽  
Cerebellar Artery ◽  
Artery Disease

Abstract The neuroradiological evaluation, perioperative medical management, and microsurgical treatment of variously located vertebral artery lesions are presented. Four types of surgical procedures were undertaken: proximal vertebral artery to common carotid artery end-to-side anastomosis; external carotid artery to midcervical vertebral artery end-to-side anastomosis; external carotid artery to distal cervical vertebral artery end-to-end anastomosis; and occipital artery to posterior inferior cerebellar artery end-to-side anastomosis. Each case is used to demonstrate the evaluation and management involved, the type of and rationale for the surgical procedure selected, and the patency of the anastomosis performed. Two points are emphasized. One is that, after careful angiographic evaluation and improved perioperative medical management, lesions of the vertebral artery are indeed amenable to microsurgical intervention with relatively low risk to the patient. The other is that, whenever possible, anastomosis of the largest caliber of vessels with the least number of suture lines is the surgical treatment of choice.

Superficial temporal and occipital artery bypass pedicles to superior, anterior inferior, and posterior inferior cerebellar arteries for vertebrobasilar insufficiency

1990 ◽  
Vol 72 (4) ◽  
pp. 554-558 ◽  
Author(s):  
James I. Ausman ◽  
Fernando G. Diaz ◽  
Dante F. Vacca ◽  
Balaji Sadasivan
Keyword(s):  
Vertebral Artery ◽  
Basilar Artery ◽  
Superficial Temporal Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Occipital Artery ◽  
Vertebrobasilar Insufficiency ◽  
Cerebellar Artery ◽  
Artery Disease

✓ Eighty-three patients underwent 85 intracranial to extracranial pedicle bypass anastomosis procedures to the posterior circulation. There were 15 patients with occipital artery (OA) to posterior inferior cerebellar artery (PICA) anastomosis, 20 patients with OA to anterior inferior cerebellar artery (AICA) anastomosis, and 50 patients with superficial temporal artery (STA) to superior cerebellar artery (SCA) anastomosis. All patients had transient ischemic attacks (TIA's) suggestive of vertebrobasilar ischemia. Twenty-seven patients had crescendo TIA's or stroke in evolution and were considered to be clinically unstable. All patients had severe bilateral distal vertebral artery or basilar artery disease. Twenty-two patients had bilateral vertebral artery occlusion and three had basilar artery occlusion. In this series, 69% had complete resolution of symptoms; the mortality rate was 8.4% and the morbidity rate 13.3%. Clinically stable patients did better than unstable patients. The STA-SCA anastomosis was well tolerated and technically less demanding than the OA-PICA or OA-AICA anastomosis procedures. Patients with symptomatic severe bilateral vertebral or basilar artery disease have a grave prognosis and the option of a surgical arterial pedicle revascularization procedure should be offered to them.

scholarly journals Usefulness of V3-Radial Artery Graft-V4 Bypass in Bilateral Fusiform Aneurysms of Vertebral Artery: Case Report

2014 ◽  
Vol 54 (3) ◽  
pp. 189-191 ◽  
Author(s):  
Norihiro SAITO ◽  
Hiroyasu KAMIYAMA ◽  
Katsumi TAKIZAWA ◽  
Seiji TAKEBAYASHI ◽  
Takeshi ASANO ◽  
...  
Keyword(s):  
Case Report ◽  
Vertebral Artery ◽  
Radial Artery ◽  
Radial Artery Graft ◽  
Artery Graft

Endovascular Management of Symptomatic Spasm of Radial Artery Bypass Graft

Neurosurgery ◽  
2010 ◽  
Vol 67 (3) ◽  
pp. 794-798 ◽  
Author(s):  
Sabareesh K. Natarajan ◽  
Erik F. Hauck ◽  
L. Nelson Hopkins ◽  
Elad I. Levy ◽  
Adnan H. Siddiqui
Keyword(s):  
Radial Artery ◽  
Moyamoya Disease ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Occipital Artery ◽  
Artery Bypass Graft ◽  
Perfusion Deficit ◽  
Radial Artery Graft ◽  
Symptomatic Vasospasm ◽  
Artery Graft

Abstract OBJECTIVE To describe the technique of endovascular access for treatment of vasospasm of a radial artery bypass graft from the occipital artery to the M3 branch of the middle cerebral artery (MCA) in a patient with moyamoya disease. CLINICAL PRESENTATION A 32-year-old woman presented with recurrent right-sided ischemic symptoms in the territory of a previous stroke. Angiographic findings were consistent with moyamoya disease, and a perfusion deficit was identified on computed tomography (CT) perfusion imaging. TECHNIQUE The patient underwent a left MCA bypass graft for flow augmentation. She returned with an occluded bypass graft, collateralization of the anterior MCA territory through a spontaneous synangiosis, and a severe perfusion deficit in the posterior MCA territory. She underwent a revision bypass graft procedure with the radial artery from the occipital artery stump to the MCA-M3 branch. She developed repeated symptomatic vasospasm of the radial artery graft postoperatively. After systemic anticoagulation, the graft was accessed through the occipital artery, and intra-arterial verapamil was injected. When this failed to resolve the graft spasm, the radial artery graft was accessed with a 0.14-inch Synchro-2 microwire (Boston Scientific, Natick Massachusetts), and sequential angioplasties were performed using over-the-wire balloons from the proximal to distal anastomosis and in the occipital artery stump. A nitroglycerin patch was applied cutaneously over the graft to relieve the vasospasm. RESULTS No complications occurred. Graft patency with robust flow was observed on the 5-month follow-up angiogram. CONCLUSION Endovascular techniques can be safely used for salvage of spastic extracranial-intracranial grafts.

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