Alternative Bypass Technique Using Radial Artery Graft between V3 Segment of Vertebral Artery and Middle Cerebral Artery: Technical Note

Yasuhiro Ito; Katsuhiko Maruichi; Naoki Nakayama; Hiroyuki Kobayashi; Ryota Tatezawa; Shinitirou Shinada; Shunsuke Terasaka

doi:10.1055/s-0043-1775989

Alternative Bypass Technique Using Radial Artery Graft between V3 Segment of Vertebral Artery and Middle Cerebral Artery: Technical Note

J Neurol Surg A Cent Eur Neurosurg. 2023 Oct 13. doi: 10.1055/s-0043-1775989. Online ahead of print.

Authors

Yasuhiro Ito¹, Katsuhiko Maruichi¹, Naoki Nakayama¹, Hiroyuki Kobayashi¹, Ryota Tatezawa¹, Shinitirou Shinada¹, Shunsuke Terasaka¹

Affiliation

¹ Department of Neurosurgery, Kashiwaba Neurosurgical Hospital, Hokkaido, Japan.

PMID: 37832591
DOI: 10.1055/s-0043-1775989

Abstract

Background: There are some cases where a radial artery (RA) graft is needed for a high-flow extracranial to intracranial (EC-IC) bypass as the external carotid artery (ECA) cannot be utilized as a donor artery. In this report, we describe two cases of extracranial vertebral artery (VA) to middle cerebral artery (MCA) high-flow bypass using an RA graft with an artificial vessel as an alternative bypass technique.

Methods: The patient was placed supine with a head rotation of 80 degrees. After frontotemporal craniotomy, another C: -shaped skin incision was made at the retroauricular region and the V3 portion of the VA was exposed at the suboccipital triangle. Prior to attempting the high-flow bypass, the superficial temporal artery (STA) was anastomosed to the M4 portion of the MCA as an insurance bypass. The RA graft was anastomosed to the V3 portion of the VA that traveled under the periosteum at the supra-auricular region through an artificial vessel. After RA-M2 anastomosis, an alternative EC-IC bypass, the V3-RA-M2 bypass, was achieved.

Results: Postoperative angiography demonstrated successful graft patency and no perioperative complications were observed in both cases.

Conclusions: In the cases where a high-flow bypass is required, the V3 portion of the VA is a suitable alternative proximal anastomosis site when the ECA is not a candidate donor. Furthermore, an artificial vessel shows satisfactory protection against graft complications.