Abstract：
OBJECTIVE: Posterior circulation cerebral bypasses often show higher risks and lower patency. Only few reports discussed occipital artery (OA)-vertebral artery (VA) bypasses. We present our illustrative cases to address current gaps in the literature on OA-VA bypass.
METHODS: A single-center retrospective review was conducted to include all institutional cases of OA-VA bypass, discussing the technique and outcomes.
RESULTS: Four institutional cases undergoing a total of 5 bypasses were evaluated, including 3 males and 1 female, with median age of 65 years (range, 62-73). All patients had vertebrobasilar insufficiency (VBI) with recurrent strokes/TIAs due to intracranial atherosclerosis, leading to unilateral VA stenosis with contralateral occlusion (1, 25%), bilateral VA stenosis (1, 25%) or occlusion (1, 25%). Medical management included aspirin for all cases (100%), with clopidogrel in 3 (75%). Surgery was performed through a far lateral approach, connecting the OA to the VA-3 segment, with no inter-positional graft. One patient underwent contralateral OA-VA bypass 6 months after the prior surgery due to worsening of the contralateral VA stenosis. Bypass patency was confirmed in all cases with post-operative angiography. All patients had clinical improvement, with one case of wound dehiscence managed conservatively. All patients were alive at last follow-up (median 7.0 months; range: 1.5-18).
CONCLUSIONS: OA-VA bypass is a challenging yet effective strategy in selected patients with VBI. Current literature lacks unique definitions of surgical indications and techniques, which we addressed in our series. Surgical education should focus on expanding the microsurgery anatomy knowledge.
METHODS: A single-center retrospective review was conducted to include all institutional cases of OA-VA bypass, discussing the technique and outcomes.
RESULTS: Four institutional cases undergoing a total of 5 bypasses were evaluated, including 3 males and 1 female, with median age of 65 years (range, 62-73). All patients had vertebrobasilar insufficiency (VBI) with recurrent strokes/TIAs due to intracranial atherosclerosis, leading to unilateral VA stenosis with contralateral occlusion (1, 25%), bilateral VA stenosis (1, 25%) or occlusion (1, 25%). Medical management included aspirin for all cases (100%), with clopidogrel in 3 (75%). Surgery was performed through a far lateral approach, connecting the OA to the VA-3 segment, with no inter-positional graft. One patient underwent contralateral OA-VA bypass 6 months after the prior surgery due to worsening of the contralateral VA stenosis. Bypass patency was confirmed in all cases with post-operative angiography. All patients had clinical improvement, with one case of wound dehiscence managed conservatively. All patients were alive at last follow-up (median 7.0 months; range: 1.5-18).
CONCLUSIONS: OA-VA bypass is a challenging yet effective strategy in selected patients with VBI. Current literature lacks unique definitions of surgical indications and techniques, which we addressed in our series. Surgical education should focus on expanding the microsurgery anatomy knowledge.
摘要：
目的：后循环脑旁路通常显示较高的风险和较低的通畅性。只有少数报道讨论枕动脉（OA）-椎动脉（VA）旁路。我们提出了我们的说明性案例，以解决OA-VA旁路文献中的当前空白。
方法：进行了单中心回顾性审查，以包括所有OA-VA旁路手术的机构病例，讨论技术和结果。
结果：评估了四个机构案例，总共进行了5次旁路，包括3名男性和1名女性，年龄中位数为65岁(范围，62-73).所有患者都有椎基底动脉供血不足（VBI），并因颅内动脉粥样硬化而复发中风/TIA，导致单侧VA狭窄并对侧闭塞（1，25％），双侧VA狭窄（1，25％）或闭塞（1，25％）。医疗管理包括所有病例的阿司匹林（100%），与氯吡格雷在3（75％）。手术是通过远外侧入路进行的，将OA连接到VA-3段，没有相互移植。由于对侧VA狭窄的恶化，一名患者在先前手术后6个月接受了对侧OA-VA旁路手术。所有患者术后血管造影均证实搭桥通畅。所有患者均有临床好转,1例伤口裂开保守处理。所有患者在最后一次随访时均存活（中位数7.0个月；范围：1.5-18）。
结论：OA-VA旁路术在选定的VBI患者中是一种具有挑战性但有效的策略。目前的文献缺乏手术适应症和技术的独特定义，我们在我们的系列中谈到了这一点。外科教育应注重拓展显微外科解剖学知识。
方法：进行了单中心回顾性审查，以包括所有OA-VA旁路手术的机构病例，讨论技术和结果。
结果：评估了四个机构案例，总共进行了5次旁路，包括3名男性和1名女性，年龄中位数为65岁(范围，62-73).所有患者都有椎基底动脉供血不足（VBI），并因颅内动脉粥样硬化而复发中风/TIA，导致单侧VA狭窄并对侧闭塞（1，25％），双侧VA狭窄（1，25％）或闭塞（1，25％）。医疗管理包括所有病例的阿司匹林（100%），与氯吡格雷在3（75％）。手术是通过远外侧入路进行的，将OA连接到VA-3段，没有相互移植。由于对侧VA狭窄的恶化，一名患者在先前手术后6个月接受了对侧OA-VA旁路手术。所有患者术后血管造影均证实搭桥通畅。所有患者均有临床好转,1例伤口裂开保守处理。所有患者在最后一次随访时均存活（中位数7.0个月；范围：1.5-18）。
结论：OA-VA旁路术在选定的VBI患者中是一种具有挑战性但有效的策略。目前的文献缺乏手术适应症和技术的独特定义，我们在我们的系列中谈到了这一点。外科教育应注重拓展显微外科解剖学知识。
