2024 Volume 52 Issue 6 Pages 409-417
Revascularization for extracranial vertebral artery (VA) dissection or VA atherosclerotic occlusive lesions caused by vertebrobasilar insufficiency or cerebral infarction is relatively rare. For VA origin stenosis, VA transposition surgery has traditionally been performed, but in recent years endovascular treatment has also been considered.
On the other hand, when bypassing from cervical external carotid artery (EC) or common carotid artery (CC) using a radial artery (RA) or saphenous vein (SV) graft, it is difficult to determine whether the recipient site should be V2 or V3 portion.
In Case 1, bilateral internal carotid occlusion and bilateral VA stenosis were treated with ischemia, and superficial temporal artery to middle cerebral artery bypass was performed followed by two-stage VA transposition. In Case 2, cervical EC-RA-V3 bypass was performed for bilateral extracranial VA dissection with onset of ischemia, and cervical CC-SV-V3 bypass was added 12 days later. In Case 3, cervical EC-RA-V2 bypass was performed for arteriosclerotic bilateral extracranial VA occlusion.
We present a case of VA transposition for VA origin stenosis and a case of posterior fossa revascularization using VA V3 and V2 portions, and report that it is important to consider each case in selecting V3 and V2 portion.
