[ECA-PCA anastomosis with the use of an interposition saphenous vein graft for vertebrobasilar progressing stroke].
A successful case undergoing the ECA-PCA bypass operation with the use of an interposition saphenous venous graft for vertebrobasilar progressing stroke was reported and details of the operative techniques were described. A 40-year-old man was admitted because of confused mental state following sudden onset of headache, vomiting, vertigo, and ataxic gait. Neurological examinations revealed he was confused and restless, and left-sided Weber's syndrome, bulbar palsy and dysphasia were noticed. CT scan showed multiple small low density areas with no enhancement scattering in both occipital lobes and cerebellar hemispheres. Angiographical studies showed that the left vertebral artery was occluded at the vertebrobasilar junction and the right vertebral artery stenosed up to 90% or more at the branching site of the PICA. There was no visualization of the vertebrobasilar system through the right posterior communicating artery. The left posterior communicating artery was not examined. The patient was treated with Urokinase amounting to 740,000 units for ten days. Thirteen days later, however, he became progressively drowsy and he became unable to speak and swallow. Quadriparesis also appeared. Progressive deterioration of these brain stem ischemic symptoms was assumed to originate from critically lowered perfusion of the vertebrobasilar circulation. Therefore, the ECA-PCA anastomosis by means of a venous graft was carried out on the right side in expectation of the rapid restoration of the blood flow in the affected brain stem. A venous graft was chosen because it would carry larger amount of blood immediately after completing the bypass surgery than small calibered arterial graft such as a superficial temporal artery.(ABSTRACT TRUNCATED AT 250 WORDS)
D000328:Adult; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D002536:Cerebral Arteries / Q000601:surgery; D002548:Cerebral Revascularization / Q000379:methods*; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D011184:Postoperative Period; D012501:Saphenous Vein / Q000637:transplantation; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000601:surgery