gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

Technical feasibility of an “extracranial posterior communicating artery” bypass for revascularisation of patients with common carotid artery occlusion

Meeting Abstract

  • U. Schneider - Neurochirurgische Klinik, Charité – Universitätsmedizin Berlin
  • P. von Weitzel-Mudersbach - Neurologisk Afdeling, Sygehus, Aarhus, Denmark
  • K.T. Hoffmann - Abteilung für Neuroradiologie, Charité – Universitätsmedizin Berlin
  • P. Vajkoczy - Neurochirurgische Klinik, Charité – Universitätsmedizin Berlin

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocDI.07-09

doi: 10.3205/09dgnc161, urn:nbn:de:0183-09dgnc1618

Published: May 20, 2009

© 2009 Schneider et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Extra-intracranial bypass surgery provides blood flow augmentation in patients suffering from intracranial or long-distance conductance artery stenosis or occlusion, which cannot be treated otherwise. The standard procedure for these cases is an anastomosis between branches of the superficial temporal artery (STA) and the middle cerebral artery (MCA). However, in patients presenting with a common carotid artery occlusion the STA, a branch of the external carotid artery, is no longer sufficiently perfused. For these patients, alternative revascularisation strategies have to be applied.

Methods: We report on a novel strategy for the revascularization of patients with common carotid artery occlusion, i.e. the “extracranial posterior communicating artery” bypass. Two patients with chronic cerebrovascular compromise resulting in transitory ischaemic attacks and/or border zone infarctions due to unilateral common carotid artery occlusion were referred to our institution. The cerebrovascular compromise was verified by positron emission tomography (PET) with and without acetazolamide stimulation. A radial artery bypass was established between the third segment of the vertebral artery and an M3 branch of the MCA at the end of the sylvian fissure. The patients were placed in park bench position; the vertebral artery was exposed between vertebral lamina of C1 and occipital bone via a paramedian linear incision. The bypass was tunnelled subcutaneously, conducted intracranially via a tailored extended burr hole craniotomy and anastomosed to a recipient M3 vessel leaving the end of the sylvian fissure.

Results: The postoperative course of both patients was uneventful concerning cerebral ischemia or bleeding complications. Both patients suffered minor wound healing disturbances, which had to be revised locally. In both patients postoperative angiographic controls revealed an excellent bypass function with markedly improved hemispheric filling of multiple MCA branches. Discharge of the patients occurred without new neurological symptoms.

Conclusions: Our novel “extracranial posterior communicating artery” bypass using a radial artery transplant from the vertebral artery to the middle cerebral artery is a useful tool in the treatment of patients suffering from haemodynamic cerebrovascular compromise due to an occlusion of the common carotid artery.