{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T07:25:43Z","timestamp":1764314743005,"version":"3.46.0"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T00:00:00Z","timestamp":1764201600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T00:00:00Z","timestamp":1764201600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"the Science and Technology Project of Tianjin Health Commission","award":["TJWJ2021MS031"],"award-info":[{"award-number":["TJWJ2021MS031"]}]},{"name":"the Tianjin Young Medical Experts Project"},{"name":"the Tianjin Key Medical Discipline (Specialty) Construction Project","award":["TJYXZDXK-022A"],"award-info":[{"award-number":["TJYXZDXK-022A"]}]},{"name":"National Distinguished Doctor Project"},{"name":"Tianjin Haihe Medical Scholar Project","award":["TJSHHYXXZ-D2-007"],"award-info":[{"award-number":["TJSHHYXXZ-D2-007"]}]},{"name":"the Tianjin \"131\" Innovative Talents Group Project"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Acta Neurochir"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Conventional surgical techniques for posterior circulation bypass have certain limitations, necessitating innovative approaches. This study evaluates the indications and outcomes of cervical carotid-to-V2 vertebral artery bypass\u2014functioning as an extracranial \"posterior communicating artery\"\u2014in the treatment of vertebrobasilar lesions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The V2 bypass procedure via a cervical anterolateral approach was applied in cases of (1) bilateral vertebral artery (VA) occlusions (Type I), (2) subclavian artery (SBA) occlusion with steal phenomenon (Type II), and (3) compensated posterior circulation aneurysm (Type III).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>All eight patients exhibited patent bypass grafts. In seven cases with anterior-to-posterior bypass flow, the carotid artery supplied the entire vertebrobasilar territory. All four Type I patients showed improved regional cerebral perfusion. Among the three Type II patients, two (with a non-dominant contralateral VA) underwent VA ligation, resulting in significant reduction of blood steal. In one patient with bilateral symmetric VAs, VA ligation was not performed due to personal reasons, and hemodynamic status remained unchanged. One Type III patient showed contrast retention within the aneurysm sac and progressive shrinkage following bypass.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The V2 bypass uses a short interposition graft between the anterior and posterior circulations, offering high flow and orthograde perfusion without complex skull base manipulation. This technique simplifies revascularization for posterior circulation ischemia, mitigates steal phenomena in SBA occlusion, and enables trans-circulatory flow modulation for compensatory aneurysms.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00701-025-06709-y","type":"journal-article","created":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T14:54:47Z","timestamp":1764255287000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cervical carotid to vertebral artery high-flow interposition graft bypass serves as an extracranial communicating pathway between anterior and posterior circulation for vertebrobasilar lesions"],"prefix":"10.1007","volume":"167","author":[{"given":"Xuan","family":"Wang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoguang","family":"Tong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jie","family":"Qiao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Minggang","family":"Shi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yanguo","family":"Shang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hu","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,11,27]]},"reference":[{"issue":"6","key":"6709_CR1","doi-asserted-by":"publisher","first-page":"e327","DOI":"10.1016\/j.wneu.2012.04.031","volume":"80","author":"FC Albuquerque","year":"2013","unstructured":"Albuquerque FC, Ahmed A, Mitha A et al (2013) Endovascular recanalization of the chronically occluded brachiocephalic and subclavian arteries: technical considerations and an argument for embolic protection. World Neurosurg 80(6):e327-336","journal-title":"World Neurosurg"},{"key":"6709_CR2","unstructured":"Alaraj A, Charbel FT, Stepleton CJ, Amin-hanjani S (2023) Extracranial vertebral artery diseases. In: Winn H (ed) Youmans & Winn Neurological Surgery, 8th ed. Elsevier Saunders Philadelphia, pp 3333\u20133348"},{"issue":"4 Suppl","key":"6709_CR3","first-page":"262","volume":"57","author":"M Bruneau","year":"2005","unstructured":"Bruneau M, Cornelius JF, George B (2005) Anterolateral approach to the V2 segment of the vertebral artery. Neurosurgery 57(4 Suppl):262\u2013267","journal-title":"Neurosurgery"},{"issue":"1","key":"6709_CR4","doi-asserted-by":"publisher","first-page":"187","DOI":"10.3171\/jns.1984.60.1.0187","volume":"60","author":"PE Camp","year":"1984","unstructured":"Camp PE (1984) Carotid to distal vertebral artery bypass for vertebrobasilar ischemia. Case report. J Neurosurg 60(1):187\u2013189","journal-title":"J Neurosurg"},{"issue":"3","key":"6709_CR5","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1177\/155005947800900302","volume":"9","author":"AL Carney","year":"1978","unstructured":"Carney AL, Anderson EM (1978) Carotid distal vertebral bypass for carotid occlusion case report and technique. Clin Electroencephalogr 9(3):105\u2013109","journal-title":"Clin Electroencephalogr"},{"issue":"5","key":"6709_CR6","doi-asserted-by":"publisher","first-page":"1296","DOI":"10.1227\/NEU.0b013e318241374b","volume":"70","author":"M Chwajol","year":"2012","unstructured":"Chwajol M, Munson TA, Alaraj A et al (2012) Extracranial carotid-vertebral bypass for endovascular access to complex posterior circulation aneurysms: a novel management approach. Neurosurgery 70(5):1296\u20131303","journal-title":"Neurosurgery"},{"issue":"1 Suppl","key":"6709_CR7","first-page":"E202","volume":"56","author":"VR Deshmukh","year":"2005","unstructured":"Deshmukh VR, Porter RW, Spetzler RF (2005) Use of \u201cbonnet\u201d bypass with radial artery interposition graft in a patient with recurrent cranial base carcinoma: technical report of two cases and review of the literature. Neurosurgery 56(1 Suppl):E202","journal-title":"Neurosurgery"},{"issue":"2","key":"6709_CR8","doi-asserted-by":"publisher","DOI":"10.3171\/2018.11.FOCUS18360","volume":"46","author":"H Duan","year":"2019","unstructured":"Duan H, Mo D, Zhang Y, Zhang J, Li L (2019) Carotid-vertebral artery bypass with saphenous vein graft for symptomatic vertebrobasilar insufficiency. Neurosurg Focus 46(2):E8","journal-title":"Neurosurg Focus"},{"issue":"3","key":"6709_CR9","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1227\/00006123-198309000-00020","volume":"3","author":"E Garrido","year":"1983","unstructured":"Garrido E, Freed MH (1983) Fatal complication of the \u201cbonnet bypass\u201d: case report. Neurosurgery 3(3):320\u2013321","journal-title":"Neurosurgery"},{"issue":"4","key":"6709_CR10","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1053\/otns.2001.30169","volume":"4","author":"B George","year":"2001","unstructured":"George B, Blanquet A, Alves O (2001) Surgical exposure of the vertebral artery. Oper Tech Neurosurg 4(4):182\u2013194","journal-title":"Oper Tech Neurosurg"},{"issue":"1","key":"6709_CR11","first-page":"33","volume":"6","author":"KF Gerke","year":"1985","unstructured":"Gerke KF, Gebarski SS, Chandler WF, Phillips TW (1985) External carotid-vertebral artery anastomosis for vertebrobasilar insufficiency. AJNR Am J Neuroradiol 6(1):33\u201337","journal-title":"AJNR Am J Neuroradiol"},{"issue":"5","key":"6709_CR12","doi-asserted-by":"publisher","first-page":"976","DOI":"10.3171\/jns.1996.85.5.0976","volume":"85","author":"H Hadeishi","year":"1996","unstructured":"Hadeishi H, Yasui N, Okamoto Y (1996) Extracranial-intracranial high-flow bypass using the radial artery between the vertebral and middle cerebral arteries. Technical note. J Neurosurg 85(5):976\u2013979","journal-title":"J Neurosurg"},{"issue":"4","key":"6709_CR13","doi-asserted-by":"publisher","first-page":"622","DOI":"10.3171\/jns.1985.63.4.0622","volume":"63","author":"MN Hadley","year":"1985","unstructured":"Hadley MN, Spetzler RF, Masferrer R et al (1985) Occipital artery to extradural vertebral artery bypass procedure. J Neurosurg 63(4):622\u2013625","journal-title":"J Neurosurg"},{"issue":"6","key":"6709_CR14","doi-asserted-by":"publisher","first-page":"1043","DOI":"10.1227\/01.NEU.0000347099.17437.64","volume":"64","author":"RA Hanel","year":"2009","unstructured":"Hanel RA, Brasiliense LB, Spetzler RF (2009) Microsurgical revascularization of proximal vertebral artery: a single-center, single-operator analysis. Neurosurgery 64(6):1043\u20131050","journal-title":"Neurosurgery"},{"issue":"10","key":"6709_CR15","doi-asserted-by":"publisher","first-page":"1993","DOI":"10.1007\/s00701-019-04001-4","volume":"161","author":"N Hecht","year":"2019","unstructured":"Hecht N, Wessels L, Fekonja L et al (2019) Bypass strategies for common carotid artery occlusion. Acta Neurochir (Wien) 161(10):1993\u20132002","journal-title":"Acta Neurochir (Wien)"},{"issue":"5","key":"6709_CR16","doi-asserted-by":"publisher","first-page":"E201","DOI":"10.1093\/ons\/opz245","volume":"17","author":"BK Hendricks","year":"2019","unstructured":"Hendricks BK, Spetzler RF (2019) Bonnet bypass for left superficial temporal artery bifurcation to right middle cerebral artery: 2-dimensional operative video. Oper Neurosurg (Hagerstown) 17(5):E201\u2013E202","journal-title":"Oper Neurosurg (Hagerstown)"},{"key":"6709_CR17","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1016\/j.wneu.2018.05.096","volume":"116","author":"Y Huang","year":"2018","unstructured":"Huang Y, Zhou P, Wang Z, Han Q (2018) Disappearance of ruptured posterior cerebral artery aneurysm associated with internal carotid artery occlusion after superficial temporal artery-to-middle cerebral artery bypass. World Neurosurg 116:178\u2013181","journal-title":"World Neurosurg"},{"key":"6709_CR18","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1016\/j.ijsu.2018.03.038","volume":"53","author":"G Illuminati","year":"2018","unstructured":"Illuminati G, Pizzardi G, Calio FG et al (2018) Results of subclavian to carotid artery bypass for occlusive disease of the common carotid artery: a retrospective cohort study. Int J Surg 53:111\u2013116","journal-title":"Int J Surg"},{"key":"6709_CR19","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2015.09.096","volume":"86","author":"M Indo","year":"2016","unstructured":"Indo M, Oya S, Matsui T (2016) Ruptured basilar tip aneurysm in a patient with bilateral internal carotid artery occlusion successfully treated with bilateral superficial temporal artery-middle cerebral artery anastomoses: case report. World Neurosurg 86:512.e5\u20138","journal-title":"World Neurosurg"},{"issue":"2","key":"6709_CR20","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1016\/j.surneu.2007.07.073","volume":"69","author":"S Kakino","year":"2008","unstructured":"Kakino S, Ogasawara K, Kubo Y et al (2008) Symptomatic occlusion at the origin of the vertebral artery treated using external carotid artery-cervical vertebral artery bypass with interposed saphenous vein graft. Surg Neurol 69(2):164\u2013168","journal-title":"Surg Neurol"},{"key":"6709_CR21","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1016\/j.jocn.2015.08.007","volume":"24","author":"MY Kalani","year":"2016","unstructured":"Kalani MY, Spetzler RF (2016) Internal carotid artery-to-posterior cerebral artery bypass for revascularization of the brainstem. J Clin Neurosci 24:151\u2013154","journal-title":"J Clin Neurosci"},{"issue":"5","key":"6709_CR22","doi-asserted-by":"publisher","first-page":"763","DOI":"10.1227\/NEU.0b013e3182870703","volume":"72","author":"MY Kalani","year":"2013","unstructured":"Kalani MY, Zabramski JM, Nakaji P, Spetzler RF (2013) Bypass and flow reduction for complex basilar and vertebrobasilar junction aneurysms. Neurosurgery 72(5):763\u2013775","journal-title":"Neurosurgery"},{"issue":"2","key":"6709_CR23","doi-asserted-by":"publisher","first-page":"290","DOI":"10.3171\/jns.1993.78.2.0290","volume":"78","author":"K Kinugasa","year":"1993","unstructured":"Kinugasa K, Sakurai M, Ohmoto T (1993) Contralateral external carotid-to-middle cerebral artery graft using the saphenous vein. Case report. J Neurosurg 78(2):290\u2013293","journal-title":"J Neurosurg"},{"issue":"1","key":"6709_CR24","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1227\/NEU.0000000000001175","volume":"79","author":"MT Lawton","year":"2016","unstructured":"Lawton MT, Abla AA, Rutledge WC et al (2016) Bypass surgery for the treatment of dolichoectatic basilar trunk aneurysms: a work in progress. Neurosurgery 79(1):83\u201399","journal-title":"Neurosurgery"},{"key":"6709_CR25","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1016\/j.jocn.2020.04.104","volume":"78","author":"LF Li","year":"2020","unstructured":"Li LF, Tsang FC, Cheng KK et al (2020) Vertebral-carotid bypass for common carotid artery occlusion. J Clin Neurosci 78:403\u2013405","journal-title":"J Clin Neurosci"},{"key":"6709_CR26","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1016\/j.avsg.2016.01.051","volume":"35","author":"Y Liu","year":"2016","unstructured":"Liu Y, Zhang J, Gu Y, Guo L, Li J (2016) Clinical effectiveness of endovascular therapy for total occlusion of the subclavian arteries: a study of 67 patients. Ann Vasc Surg 35:189\u2013196","journal-title":"Ann Vasc Surg"},{"issue":"5","key":"6709_CR27","first-page":"E1159","volume":"56","author":"VJ Miele","year":"2005","unstructured":"Miele VJ, Rosen CL, Carpenter J et al (2005) Vertebral artery-to-middle cerebral artery bypass with coil embolization of giant internal carotid artery aneurysm: technical case report. Neurosurgery 56(5):E1159","journal-title":"Neurosurgery"},{"issue":"5","key":"6709_CR28","doi-asserted-by":"publisher","first-page":"665","DOI":"10.1097\/00005537-199705000-00020","volume":"107","author":"T Numata","year":"1997","unstructured":"Numata T, Konno A, Takeuchi Y et al (1997) Contralateral external carotid-middle cerebral artery bypass for carotid artery resection. Laryngoscope 107(5):665\u2013670","journal-title":"Laryngoscope"},{"issue":"5","key":"6709_CR29","first-page":"640","volume":"57","author":"DM \u00d6zdemir-VAN Brunschot","year":"2016","unstructured":"\u00d6zdemir-VAN Brunschot DM, Reijnen MM et al (2016) Endovascular versus surgical revascularization in proximal subclavian artery obstruction. J Cardiovasc Surg (Torino) 57(5):640\u2013645","journal-title":"J Cardiovasc Surg (Torino)"},{"issue":"22","key":"6709_CR30","doi-asserted-by":"publisher","first-page":"2320","DOI":"10.1161\/CIRCULATIONAHA.113.006653","volume":"129","author":"BJ Potter","year":"2014","unstructured":"Potter BJ, Pinto DS (2014) Subclavian steal syndrome. Circulation 129(22):2320\u20132323","journal-title":"Circulation"},{"issue":"6","key":"6709_CR31","doi-asserted-by":"publisher","first-page":"1783","DOI":"10.1227\/NEU.0b013e3181fa325b","volume":"67","author":"UC Schneider","year":"2010","unstructured":"Schneider UC, von Weitzel-Mudersbach P, Hoffmann KT, Vajkoczy P (2010) Extracranial posterior communicating artery bypass for revascularization of patients with common carotid artery occlusion. Neurosurgery 67(6):1783\u20131789","journal-title":"Neurosurgery"},{"issue":"4","key":"6709_CR32","first-page":"1083","volume":"51","author":"S Terasaka","year":"2002","unstructured":"Terasaka S, Itamoto K, Houkin K (2002) Basilar trunk aneurysm surgically treated with anterior petrosectomy and external carotid artery-to-posterior cerebral artery bypass: technical note. Neurosurgery 51(4):1083\u20131087","journal-title":"Neurosurgery"},{"issue":"3","key":"6709_CR33","doi-asserted-by":"publisher","first-page":"263","DOI":"10.2176\/nmc.50.263","volume":"50","author":"S Toyota","year":"2010","unstructured":"Toyota S, Iwaisako K, Wakayama A, Yoshimine T (2010) Fixation and protective method for the interposition graft in bonnet bypass\u2013technical note. Neurol Med Chir (Tokyo) 50(3):263\u2013266","journal-title":"Neurol Med Chir (Tokyo)"},{"key":"6709_CR34","doi-asserted-by":"publisher","first-page":"1202257","DOI":"10.3389\/fneur.2023.1202257","volume":"14","author":"X Wang","year":"2023","unstructured":"Wang X, Tong X (2023) Vascular reconstruction related to the extracranial vertebral artery: the presentation of the concept and the basis for the establishment of the bypass system. Front Neurol 14:1202257","journal-title":"Front Neurol"},{"issue":"5","key":"6709_CR35","doi-asserted-by":"publisher","first-page":"527","DOI":"10.1093\/ons\/opy143","volume":"16","author":"X Wang","year":"2019","unstructured":"Wang X, Tong X, Shi M, Shang Y, Wang H (2019) Occipital artery to extradural vertebral artery bypass for posterior circulation ischemia. Oper Neurosurg (Hagerstown) 16(5):527\u2013538","journal-title":"Oper Neurosurg (Hagerstown)"},{"issue":"6","key":"6709_CR36","doi-asserted-by":"publisher","first-page":"1164","DOI":"10.1016\/j.wneu.2014.02.034","volume":"82","author":"T Yang","year":"2014","unstructured":"Yang T, Tariq F, Duong HT, Sekhar LN (2014) Bypass using V2\u2013V3 segment of the vertebral artery as donor or recipient: technical nuances and results. World Neurosurg 82(6):1164\u20131170","journal-title":"World Neurosurg"},{"issue":"6","key":"6709_CR37","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1007\/s007010050356","volume":"141","author":"IM Ziyal","year":"1999","unstructured":"Ziyal IM, Sekhar LN, Chandrasekar K, Bank WO (1999) Vertebral artery to common carotid artery bypass in Takayasu\u2019s disease with delayed cerebral ischemia. Acta Neurochir (Wien) 141(6):655\u2013659","journal-title":"Acta Neurochir (Wien)"}],"container-title":["Acta Neurochirurgica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00701-025-06709-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00701-025-06709-y\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00701-025-06709-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T07:20:58Z","timestamp":1764314458000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00701-025-06709-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,27]]},"references-count":37,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["6709"],"URL":"https:\/\/doi.org\/10.1007\/s00701-025-06709-y","relation":{},"ISSN":["0942-0940"],"issn-type":[{"type":"electronic","value":"0942-0940"}],"subject":[],"published":{"date-parts":[[2025,11,27]]},"assertion":[{"value":"26 May 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 October 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 November 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"This study was approved by the Research Ethics Review Committee of Tianjin Huanhu Hospital in accordance with the Declaration of Helsinki.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Patients provided signed informed consent for the publication of their data and photographs.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to publish"}},{"value":"The authors declare no competing interests.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"299"}}