case_images: PMC3740606_01
case_images: Imaging results for a 70-year-old male (Case 1) with right VA occlusion who underwent OA-PCA anastomosis via the right occipital interhemispheric approach. Illustration showing OA-PCA bypass (a). Preoperative angiography demonstrated occlusion of the right VA (b) and that the left VA terminated at the posterior inferior cerebellar artery. Collateral circulation was demonstrated in the right posterior communicating artery through the diminutive internal carotid artery to upper basilar artery on angiography (c). Postoperative angiography demonstrates patency of the bypass (d; arrow). VA, vertebral artery; OA, occipital artery; PCA, posterior cerebral artery
case_images: SNI-4-90-g002.jpg
case_images: PMC3740606_01_SNI-4-90-g002.jpg
case_images: F1
case_images: Angiography revealed right VA occlusion and a left VA terminating in a PICA [Figure 1b]. Collateral circulation was identified in the distal basilar artery via the diminutive posterior communicating artery of the stenotic right internal carotid artery [Figure 1c]. The patient underwent right OA-PCA bypass at 26 days after hospital admission [Figure 1a]. Postoperative angiography revealed patency of the bypass [Figure 1d].
case_images: PMC3740606_02
case_images: Imaging results for a 65-year-old male (Case 2) with occlusion of the BA who underwent OA-PICA and OA-SVG-PCA anastomosis in the same operating sequence. Illustration showing OA-PICA and OA-SVG-PCA bypass (a). Preoperative angiography demonstrated occlusion of the midbasilar artery and severe stenosis of the left VA and PICA (b). MCA-to-PCA leptomeningeal collateral circulation was demonstrated in the PCA territory on angiography. The OA-PICA anastomosis was performed using a left transcondylar approach (arrow). We subsequently performed right OA-SVG bypass in the same position through an occipital interhemispheric approach (arrow). Proximal anastomosis was made in a side-to-end fashion using the side branch of the OA (a, c). Postoperative angiography demonstrates antegrade flow of the distal VA to the BA through the OA-PICA bypass (c). OA-SVG-PCA bypass was also patent and may function as a double insurance (c). BA, basilar artery; OA, occipital artery; PCA, posterior cerebral artery. PICA, posterior inferior cerebellar artery; SVG, saphenous vein; VA, vertebral artery; MCA, middle cerebral artery
case_images: SNI-4-90-g003.jpg
case_images: PMC3740606_02_SNI-4-90-g003.jpg
case_images: F2
case_images: Angiography revealed severe stenosis of the left VA, occlusion of the mid-basilar artery, and leptomeningeal anastomosis from the MCA to the PCA [Figure 2b]. The patient underwent successful left OA-PICA bypass and right OA-SVG-PCA bypass [Figure 2a]. Postoperative angiography revealed opacification of the left distal VA through the OA-PICA bypass and opacification of the upper basilar artery via the OA-PCA bypass [Figure 2c].
case_images: PMC3740606_03
case_images: Imaging results for a 51-year-old male (Case 3) with right posterior cerebral aneurysm who underwent OA-STA-PCA anastomosis through an occipital interhemispheric approach prior to trapping of the aneurysm using an intravascular procedure. Left vertebral angiography showing coil compaction of the posterior cerebral artery aneurysm (a; black arrow). Postoperative angiography showing complete obliteration of the aneurysm and patency of the OA-RA-PCA bypass (b; white arrow). OA, occipital artery; STA, superficial temporal artery; PCA, posterior cerebral artery; RA, radial artery
case_images: SNI-4-90-g004.jpg
case_images: PMC3740606_03_SNI-4-90-g004.jpg
case_images: F3
case_images: Follow-up examination by cerebral angiography at 1 month demonstrated recurrence of coil compaction [Figure 3a]. Three-dimensional CT revealed bypass patency [Figure 3b].