EXTRACRANIAL-INTRACRANIAL SAPHENOUS-VEIN BYPASS FOR CAROTID OR VERTEBRAL ARTERY DISSECTIONS - A REPORT OF 6 CASES

The management of carotid or vertebral artery dissections has generall y been either conservative (with anticoagulation) or surgical (by prox imal ligation or trapping procedures). However, identification and man agement of those patients with a high risk of stroke recurrence have b een difficult. Six patients with carotid or vertebral artery dissectio ns underwent a total of seven surgical procedures involving intracrani al interpositional saphenous vein bypass grafts anastomosed distally b eyond the point of dissection with trapping of the intermediate diseas ed section of the artery. lt is suggested that this procedure be used in patients who have bilateral carotid or vertebral artery disease, pe rsistent angiographic abnormalities (particularly aneurysms), or recur ring ischemic events while undergoing anticoagulation therapy, or in w hom anticoagulation is undesirable. This procedure has benefits over c urrent surgical options because of the maintenance of high flow, the a voidance of abnormal watershed areas of flow, and the elimination of t he risk of emboli. The procedure is compared to previous techniques of extracranial-intracranial bypass.