Internal Carotid Artery-To-Posterior Cerebral Artery Bypass for Revascularization of the Brainstem

Department

neurosurgery

Document Type

Article

Abstract

We describe a novel bypass technique used to revascularize the brainstem by anastomosing the internal carotid artery (ICA) to the posterior cerebral artery (PCA) using a radial artery graft, effectively creating a functional alternative to the posterior communicating artery. A 72-year-old male patient presented with rapidly progressive neurological symptoms attributable to brainstem compression; imaging showed a giant, fusiform, partially thrombosed, vertebrobasilar artery aneurysm. An Alcock's test revealed no significant collateral circulation from the posterior communicating arteries. To revascularize the top of the basilar artery, we performed an ICA-to-PCA bypass using a radial artery interposition graft. Specifically, we used the radial artery graft to connect the supraclinoid ICA to the P2 segment of the PCA. The basilar artery was subsequently occluded during the same operation by placing a clip below the superior cerebellar arteries. Although the bypass remained patent, the patient suffered an acute thrombosis of the aneurysm, resulting in fatal pontine infarction.

Publication Date

2016

Publication Title

Journal of Clinical Neuroscience

ISSN

0967-5868

Volume

24

First Page

151

Last Page

154

Digital Object Identifier (DOI)

10.1016/j.jocn.2015.08.007

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