Occipital artery bypass

Superficial temporal artery to middle cerebral artery bypass helps treat cerebral ischemia. However, the Superficial temporal artery is not available for bypass in some conditions. Therefore, with some technical tips, Hong et al. introduced a bypass technique using the occipital artery (OA).

Two female patients complained of hemiparesis. Brain magnetic resonance imaging (MRI) indicated contralateral infarction from the MCA steno-occlusion. On Diamox single photon emission computed tomography or perfusion MRI, the contralateral front parietotemporal reserve was diminished. On transfemoral cerebral angiography, the STA was thin with a weak flow; however, the OA was prominent. Direct OA-MCA end-to-side extracranial-intracranial bypass surgery was implemented instead of STA because the caliber was too narrow. The postoperative course was uneventful in both cases, with well-maintained bypass patency and neurological stability during follow-up.

Conclusion: OA might be an acceptable alternative for MCA cerebral ischemic cases with an unsuitable STA ¹⁾