Vertebral artery V3 portion-radial artery-distal common carotid artery (V3-RA-dCCA) bypass for large basilar trunk aneurysm with bilateral proximal common carotid artery occlusion—technical note

• Published in: Acta neurochirurgica Vol. 164; no. 4; pp. 1031 - 1035
• Main Authors: Matano, Fumihiro, Tamaki, Tomonori, Yamazaki, Michio, Enomoto, Hiroyuki, Tateyama, Kojiro, Mizunari, Takayuki, Murai, Yasuo, Morita, Akio
• Format: Journal Article
• Language: English
• Published: Vienna Springer Vienna 01-04-2022; Springer Nature B.V
• Subjects: Aged; Albumin; Aneurysm; Aneurysm - surgery; Aneurysms; Angiography; Basilar Artery - surgery; Blood flow; Carotid arteries; Carotid artery; Carotid Artery Diseases; Carotid Artery, Common - surgery; Carotid Artery, Internal - surgery; Cerebral blood flow; Cerebral Revascularization; Female; Forearm; Humans; Interventional Radiology; Intracranial Aneurysm - surgery; Ischemia; Medicine; Medicine & Public Health; Minimally Invasive Surgery; Neurology; Neuroradiology; Neurosurgery; Radial Artery - diagnostic imaging; Radial Artery - surgery; Sternocleidomastoid muscle; Surgical Orthopedics; Technical Note - Vascular Neurosurgery - Aneurysm; Veins & arteries; Vertebrae; Vertebral Artery - diagnostic imaging; Vertebral Artery - surgery; Vertebral artery; Common carotid artery; Basilar trunk aneurysm; Radial artery
• ISSN: 0942-0940; 0001-6268; 0942-0940
• DOI: 10.1007/s00701-021-04930-z

Background
Large basilar trunk aneurysm caused by bilateral occlusion of the proximal common carotid artery is rare. We treated one case with vertebral V3 portion-radial artery-distal common carotid artery (V3-RA-dCCA) bypass.
Case description
Basilar trunk aneurysm and bilateral occlusion of the proximal CCA were found incidentally in a 70-year-old woman. During the next 5 years, the aneurysm gradually enlarged to 12 mm, and blood flow of the anterior circulation was supplied through the posterior communicating artery. V3-RA-dCCA bypass was performed to reduce the stress of blood flow and prevent aneurysm growth and rupture. After exposing the neck portion, forearm of RA, and V3 portion of the vertebral artery, we created a space just below the sternocleidomastoid muscle to bypass the RA. We flushed the RA with albumin to stiffen the artery and temporarily clamped the bilateral sides of the RA to prevent twisting. We anastomosed the V3 and RA with a 9–0 thread and temporarily clamped the V3. After flushing the RA with albumin to prevent twisting, we clamped the external and internal carotid arteries, opened the dCCA with a vascular punch to prevent arterial dissection, and anastomosed the RA to the dCCA. The patency of the bypass was confirmed with Doppler and indocyanine green video angiography. The postoperative course was uneventful, bypass patency was good, and the aneurysm did not expand further.
Conclusion
V3-RA-dCCA bypass may be an effective and low-risk treatment for large basilar trunk aneurysms with bilateral occlusion of the proximal common carotid artery.