title: Construction of a new posterior communicating artery in a patient with poor posterior fossa circulation: technical case report.
abstract: OBJECTIVE
  The carotid and the vertebrobasilar circulation were connected, effectively creating a new posterior communicating artery (PComA). The excimer laser-assisted nonocclusive anastomosis technique is a new anastomosis technique whereby formerly untreatable patients may be treated with an intracranial artery-to-intracranial artery bypass procedure. This report is the first one in which an angiographically proved patent internal carotid artery-posterior cerebral artery segment P1 bypass is presented.
  
  
  METHODS
  Our patient presented with repeated episodes of vertebrobasilar ischemia because of vertebral artery occlusion and stenosis.
  
  
  METHODS
  An internal carotid artery-posterior cerebral artery segment P1 bypass procedure was performed. Because the patient experienced transient ischemia in the left cerebral hemisphere at the end of postoperative angiography procedure, no radiological intervention was performed, and the patient refused to undergo a new radiological intervention at a later stage.
  
  
  METHODS
  Both anastomoses were made using the excimer laser-assisted nonocclusive anastomosis technique.
  
  
  CONCLUSIONS
  Intraoperative flowmetry was performed using an ultrasound flowmeter, which disclosed blood flow of 35 ml/min through the bypass. We hope that this new PComA suffices to protect the patient from infarction in the territory of the vertebrobasilar circulation.
authors.affiliation: Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands. HStreefk@azu.nl
authors.forename: Cornelis A F
authors.initials: CA
authors.lastname: Tulleken
authors.forename: Henk Johan N
authors.initials: HJ
authors.lastname: Streefkerk
authors.forename: Albert
authors.initials: A
authors.lastname: van der Zwan
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000601:surgery*; D002533:Cerebral Angiography; D002548:Cerebral Revascularization / Q000379:methods*; D003388:Cranial Fossa, Posterior / Q000098:blood supply*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D020762:Infarction, Posterior Cerebral Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D020769:Posterior Cerebral Artery / Q000000981:diagnostic imaging / Q000601:surgery; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*