Answer
In unusual circumstances, vertebral artery bypass may be considered; however, this surgical procedure remains an unproven therapy. Extracranial (EC)-to-intracranial (IC) vertebral artery bypass may be undertaken by connection of the occipital artery to the vertebral, superior cerebellar, anterior internal carotid artery (ICA), or posterior ICA. The superficial temporal artery has also been used as a donor artery. Shunting to the posterior cerebral artery (PCA) may be accomplished by using veins or synthetic grafts. In general, EC-to-IC circulation shunting has been relegated to use in extenuating circumstances since the publication of the negative EC-IC bypass trial. [21]
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Media Gallery
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Unenhanced head computed tomography (CT) scan demonstrating a subacute L posterior cerebral artery (PCA) infarct.
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Unenhanced head computed tomography (CT) scan demonstrating hemorrhagic conversion of an ischemic stroke, approximately 72 hours after symptom onset.
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Brain magnetic resonance imaging (MRI) scan demonstrating acute stroke. Diffusion restriction is seen on diffusion-weighted imaging.
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Magnetic resonance (MR) angiogram demonstrating bilateral fetal posterior cerebral artery (PCA) variants (black arrows) with the basilar artery terminating in bilateral superior cerebellar arteries (blue arrows).
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Computed tomography (CT) scan of the brain showing hypodense areas in the right occipital lobe consistent with a recent posterior cerebral artery (PCA) ischemic infarct.
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