{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T10:26:46Z","timestamp":1770114406051,"version":"3.49.0"},"reference-count":26,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","license":[{"start":{"date-parts":[[2025,1,20]],"date-time":"2025-01-20T00:00:00Z","timestamp":1737331200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2025,1,20]]},"abstract":"\n BACKGROUND<\/jats:title>\n The presence of significant tortuosity in access routes to aneurysms can interfere with catheter guidance and manipulation and significantly impact treatment strategies.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n In this report, the authors combined intentional staged aneurysm embolization with the construction of a new direct access route, which they call a \u201chighway bypass,\u201d for a symptomatic posterior circulation cerebral aneurysm that was difficult to access with a catheter. Notably, the highway bypass is used for catheter passage, and technical tips should be considered. The patient had a symptomatic unruptured cerebral aneurysm in the first segment of the left posterior cerebral artery with bilateral internal carotid artery occlusion and severe tortuosity of the bilateral vertebral arteries. The highway bypass using a radial artery graft was performed in the first stage; in the second stage, the aneurysm was accessed using the graft, and embolization was performed. The catheter was passed through the graft without complications. The aneurysm was successfully embolized, no ischemic lesions were found in the postoperative images, and the patient was discharged without worsening neurological findings.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n Intentional staged aneurysm embolization combined with the highway bypass effectively treats aneurysms that are difficult to access. Anastomoses should be designed to allow catheters to pass through the graft.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE24527<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case24527","type":"journal-article","created":{"date-parts":[[2025,1,20]],"date-time":"2025-01-20T15:54:05Z","timestamp":1737388445000},"source":"Crossref","is-referenced-by-count":0,"title":["Intentional staged embolization via the \u201chighway bypass\u201d using a radial artery graft for a large posterior circulation aneurysm: illustrative case"],"prefix":"10.3171","volume":"9","author":[{"given":"Masahiro","family":"Indo","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Higashi Yamato Hospital, Higashi Yamato, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Soichi","family":"Oya","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sho","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Higashi Yamato Hospital, Higashi Yamato, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ikuo","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Higashi Yamato Hospital, Higashi Yamato, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shinsuke","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Saitama Medical University, Saitama Medical Center, Kawagoe, Saitama, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masaaki","family":"Shojima","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Teikyo University Hospital, Itabashi-Ku, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shigeru","family":"Nemoto","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kanto Rosai Hospital, Kanagawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"3","key":"bib1","series-title":"Eur J Radiol","first-page":"178","article-title":"Giant intracranial aneurysms: development, clinical presentation and treatment","volume":"46","author":"Choi","year":"2003","unstructured":"Choi ISDavid C. Giant intracranial aneurysms: development, clinical presentation and treatment. Eur J Radiol. 2003;46(3):178-194."},{"key":"bib2","series-title":"World Neurosurg","first-page":"293","article-title":"Giant intracranial aneurysms: surgical treatment and analysis of risk factors","volume":"102","author":"Xu","year":"2017","unstructured":"Xu LDeng XWang S, et al. Giant intracranial aneurysms: surgical treatment and analysis of risk factors. World Neurosurg. 2017;102:293-300."},{"issue":"7","key":"bib3","series-title":"J Neurointerv Surg","first-page":"718","article-title":"Distal access using hyperflexible atraumatic distal tip with optimized proximal stability of the Benchmark intracranial guide catheter for the treatment of cerebral vascular diseases: a technical note","volume":"8","author":"Chandran","year":"2016","unstructured":"Chandran APuthuran MEldridge PRNahser HC. Distal access using hyperflexible atraumatic distal tip with optimized proximal stability of the Benchmark intracranial guide catheter for the treatment of cerebral vascular diseases: a technical note. J Neurointerv Surg. 2016;8(7):718-721."},{"issue":"6","key":"bib4","series-title":"Neurosurgery","first-page":"1677","article-title":"The versatile distal access catheter: the Cleveland Clinic experience","volume":"68","author":"Spiotta","year":"2011","unstructured":"Spiotta AMHussain MSSivapatham T, et al. The versatile distal access catheter: the Cleveland Clinic experience. Neurosurgery. 2011;68(6):1677-1686."},{"issue":"1","key":"bib5","series-title":"Neurosurgery","first-page":"250","article-title":"Large aneurysm in a nonbifurcating cervical carotid artery: an aneurysm associated with a rare anomaly treated with radial artery graft bypass: case report","volume":"68","author":"Tokugawa","year":"2011","unstructured":"Tokugawa JYoshida KYamamoto MKamiyama HOishi HArai H. Large aneurysm in a nonbifurcating cervical carotid artery: an aneurysm associated with a rare anomaly treated with radial artery graft bypass: case report. Neurosurgery. 2011;68(1suppl Operative):250-253."},{"issue":"5","key":"bib6","series-title":"Acta Neurochir (Wien)","first-page":"1281","article-title":"Horizontal stent deployment via extracranial-intracranial bypass in coil embolization of basilar apex aneurysms: technical report","volume":"164","author":"Ishiguro","year":"2022","unstructured":"Ishiguro TKawashima ANomura S, et al. Horizontal stent deployment via extracranial-intracranial bypass in coil embolization of basilar apex aneurysms: technical report. 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Coiling of a residual internal carotid artery aneurysm via an extracranial-intracranial bypass graft following parent vessel occlusion. Br J Neurosurg. 2012;26(5):759-762."},{"key":"bib10","series-title":"Interv Neuroradiol","article-title":"Safety and efficacy of transgraft internal trapping after proximal internal carotid artery ligation with high","author":"Dofuku","unstructured":"Dofuku STsuruta WHosoo HHara TMatsumaru Y. Safety and efficacy of transgraft internal trapping after proximal internal carotid artery ligation with high-flow bypass. Interv Neuroradiol. 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J Neurosurg. 2002;96(1):135-139."},{"issue":"5","key":"bib12","series-title":"Neurosurgery","first-page":"1296","article-title":"Extracranial carotid-vertebral bypass for endovascular access to complex posterior circulation aneurysms: a novel management approach","volume":"70","author":"Chwajol","year":"2012","unstructured":"Chwajol MMunson TAAlaraj ACharbel FTAletich VAAmin-Hanjani S. Extracranial carotid-vertebral bypass for endovascular access to complex posterior circulation aneurysms: a novel management approach. Neurosurgery. 2012;70(5):1296-12304."},{"key":"bib13","series-title":"World Neurosurg","first-page":"879.e1","article-title":"Coiling of a ruptured large internal carotid artery aneurysm via extracranial-intracranial saphenous vein bypass graft just after proximal ligation of the internal carotid artery","volume":"98","author":"Tajima","year":"2017","unstructured":"Tajima HAraki YIzumi TNishihori MOkamoto SWakabayashi T. Coiling of a ruptured large internal carotid artery aneurysm via extracranial-intracranial saphenous vein bypass graft just after proximal ligation of the internal carotid artery. 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