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. 2020 Aug 3;88(1):82–95. doi: 10.1093/neuros/nyaa317

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© Congress of Neurological Surgeons 2020.

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

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FIGURE 7. — Imaging studies of a case of remote proximal parent artery occlusion (RPO) with high-flow radial artery graft bypass from the extracranial vertebral artery (VA) to the posterior cerebral artery (PCA) (see Video, Supplemental Digital Content, first case). A 57-yr-old man presented with brainstem compression syndrome caused by bilateral large fusiform and dolichoectatic aneurysms of the vertebrobasilar junction (VBJ-BLFDA). A, Preoperative T1-weighted MR image with gadolinium demonstrated significant brainstem compression by the aneurysm. B, Preoperative bilateral vertebral angiogram revealing VBJ-BLFDA. C, Postoperative angiogram showing disappearance of the right VA aneurysm and patent extracranial VA to PCA bypass. D, Postoperative T1-weighted MR image showing complete thrombosis of the right VA aneurysm. Follow-up angiogram revealed slight enlargement of the left VA aneurysm E, so was occluded with a balloon at the C1-2 level 9 mo after initial treatment F. G, Postendovascular occlusion MR image revealed successful left VA aneurysm thrombosis. H, Recent T1-weighted MR image showed stable aneurysms on both sides at 184 mo after the treatment.