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Patient 3: (a) MRI SPACE sequence showing intra-luminal thrombus; Virtual contrast simulations: (b) Preoperative flow conditions; (c) Option 1. Dominant vertebral clip with a vertebral-to-PCA bypass; (d) Option 2.Clipping smaller vertebral and basilar apex with a bypass from dominant vertebral to PCA; (e) Option 3.MCA-to-PCA bypass and clipping the basilar apex distal to SCAs. The simulations show inadequate flow through the perforators for all considered options.
