Abstract
We report our 10 years of experience with the use of radial artery bypass grafts to treat large or giant vertebro-basilar artery aneurysms (5 patients, 2 of whom had a ruptured aneurysm and 3 of whom showed deterioration by medical treatment). All were diagnosed as unclippable in preoperative examinations.
Prophylactic vascular reconstruction to the rostral brainstem before treating the aneurysm was required. Radial artery bypass grafts were adopted between intracranial vertebral artery (V4) and proximal basilar artery (V4-RA-BA, n=1), vertebral artery (V3) and distal basilar artery (V3-RA-BA, n=1), vertebral artery (V3) and posterior cerebral artery (V3-RA-PCA, n=2), and proximal superficial temporal artery and posterior cerebral artery (STA-RA-PCA, n=1). Aneurysms were treated by proximal ligation (n=1), excision (n=1), intraoperative coil embolization (n=1) and direct clipping (n=1). In one case in which STA-RA-PCA bypass was performed, intolerance of the proximal basilar artery occlusion was shown by intraoperative SEP monitoring. The aneurysm remained without any treatment.
Excellent or good results were achieved in 2 patients. One patient was unchanged. One patient, in whom the basilar artery was totally occluded although the graft remained patent, worsened. One patient died of acute myocardial infarction.
Our results indicate that the vascular reconstruction to the rostral brainstem, especially the high flow bypass, should be considered whenever proximal basilar artery occlusion is performed in aneurysm patients.
