Vertebral artery surgery with cardiopulmonary bypass and deep hypothermia

Deep hypothermia was proposed to prevent neuronal ischemia and stroke durin g surgical procedures on arteries that supply the brain, especially with ex tended occlusive lesions on both internal carotid arteries. The interest of this therapeutic option is still under discussion, even in the case of com bined cardiac and cerebrovascular surgery. We report the case of a 53-year- old male who was admitted to our institution for symptomatic vertebrobasila r insufficiency. Angiography showed a thrombosis of both internal carotid a rteries, stenosis of both external carotid arteries, and a tight proximal s tenosis of a dominant right vertebral artery. Endarterectomy and angioplast y of the origin of the right external carotid artery was done first to incr ease the blood supply to the brain via collateral arteries connecting the e xtra- and intracranial networks. Six weeks after this, a right-sided verteb ral-to-carotid artery anastomosis was performed during cardiopulmonary bypa ss (CPB)-induced deep hypothermia for optimal neuronal protection, with goo d results. However, early thrombosis of the right vertebral artery requirin g reintervention in normothermia, without any stroke, indicate that deep hy pothermia was unnecessary in this case, probably because of the previous na tural and surgical development of collateral circulation However, there was no means of predicting this in a reliable manner before the procedure and deep hypothermia appeared a safe technique for neuronal protection without any specific postoperative complications.