{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T22:27:44Z","timestamp":1769725664390,"version":"3.49.0"},"reference-count":38,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","license":[{"start":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T00:00:00Z","timestamp":1754870400000},"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":[[2025,8,11]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>An occipital artery\u2013vertebral artery (OA-VA) anastomosis is rarely observed on cerebral angiography. The authors present a case of posterior circulation infarction during carotid artery stenting (CAS) due to an OA-VA anastomosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 73-year-old male presented with mild right internal carotid artery (ICA) stenosis, which progressed to near occlusion over 18 months. Cerebral angiography revealed anterograde flow from the external carotid artery (ECA) to the vertebrobasilar system via the OA-VA anastomosis, which was not recognized by the surgeons before treatment. CAS using a flow reversal technique was performed to prevent distal embolization in the ICA. MRI the day after CAS revealed cerebral infarcts in both cerebellar hemispheres and on the right side of the pons, possibly due to emboli that migrated via the OA-VA anastomosis into the ECA during CAS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>As ICA stenosis progresses, an OA-VA anastomosis that was initially invisible on cerebral angiography may become apparent. Since this anastomosis can serve as a pathway for embolic migration during CAS, which can lead to posterior circulation infarction, it is essential to perform CAS in a manner that prevents embolic migration into the ECA in patients with OA-VA anastomoses.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE25187\">https:\/\/thejns.org\/doi\/10.3171\/CASE25187<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25187","type":"journal-article","created":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T23:43:54Z","timestamp":1754955834000},"source":"Crossref","is-referenced-by-count":0,"title":["Occipital artery\u2013vertebral artery anastomosis visualized by cerebral angiography due to progression of internal carotid artery stenosis: illustrative case"],"prefix":"10.3171","volume":"10","author":[{"given":"Natsuki","family":"Akaike","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5710-7456","authenticated-orcid":true,"given":"Hiroyuki","family":"Ikeda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takuya","family":"Osuki","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Minami","family":"Uezato","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masanori","family":"Kinosada","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0738-760X","authenticated-orcid":true,"given":"Yoshitaka","family":"Kurosaki","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masaki","family":"Chin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"2","key":"bib1","series-title":"Zentralbl Neurochir","first-page":"76","article-title":"Zur Frage der Anastomosen zwischen der A. vertebralis und der A. occipitalis","volume":"16","author":"Schulze","year":"1956","unstructured":"Schulze HASauerbrey A.Zur Frage der Anastomosen zwischen der A. vertebralis und der A. occipitalis. Zentralbl Neurochir. 1956;16(2):76-80."},{"key":"bib2","series-title":"J Neurosurg","first-page":"758","article-title":"The occipital-vertebral anastomosis","volume":"21","author":"Schechter","year":"1964","unstructured":"Schechter MM.The occipital-vertebral anastomosis. J Neurosurg. 1964;21:758-762."},{"issue":"1","key":"bib3","series-title":"Rinsho Hoshasen","first-page":"17","article-title":"Occipital-vertebral anastomosis","volume":"20","author":"Gito","year":"1975","unstructured":"Gito YKowada MMiyasaka KTakahashi M.Occipital-vertebral anastomosis. Article in Japanese. Rinsho Hoshasen. 1975;20(1):17-22."},{"issue":"2","key":"bib4","series-title":"Surg Neurol","first-page":"160","article-title":"Sudden appearance of occipital-vertebral arterial anastomoses during therapeutic embolization","volume":"24","author":"Bitoh","year":"1985","unstructured":"Bitoh SHasegawa HObashi JMaruno M.Sudden appearance of occipital-vertebral arterial anastomoses during therapeutic embolization. Surg Neurol. 1985;24(2):160-164."},{"issue":"6","key":"bib5","series-title":"J Neurosurg","first-page":"849","article-title":"Spontaneous opening of large occipital-vertebral artery anastomosis during embolization. Case report","volume":"53","author":"Spetzler","year":"1980","unstructured":"Spetzler RFModic MBonstelle C.Spontaneous opening of large occipital-vertebral artery anastomosis during embolization. Case report. J Neurosurg. 1980;53(6):849-850."},{"issue":"1","key":"bib6","series-title":"AJNR Am J Neuroradiol","first-page":"71","article-title":"Extra- to intracranial arterial anastomoses in therapeutic embolization: recognition and role","volume":"1","author":"Ahn","year":"1980","unstructured":"Ahn HSKerber CWDeeb ZL.Extra- to intracranial arterial anastomoses in therapeutic embolization: recognition and role. AJNR Am J Neuroradiol. 1980;1(1):71-75."},{"issue":"7","key":"bib7","series-title":"J Med Assoc Thai","first-page":"426","article-title":"Posterior fossa stroke in a patient undergoing embolization of occipital artery: a case report","volume":"70","author":"Issaragrisl","year":"1987","unstructured":"Issaragrisl RBhoopat WKanpittaya C.Posterior fossa stroke in a patient undergoing embolization of occipital artery: a case report. J Med Assoc Thai. 1987;70(7):426-430."},{"issue":"2","key":"bib8","series-title":"Interv Neuroradiol","first-page":"212","article-title":"Carotid artery stenting for patients with occipital-vertebral anastomosis","volume":"25","author":"Kajikawa","year":"2019","unstructured":"Kajikawa RFujinaka TNakamura HKinoshita MNishida TKishima H.Carotid artery stenting for patients with occipital-vertebral anastomosis. Interv Neuroradiol. 2019;25(2):212-218."},{"issue":"4","key":"bib9","series-title":"Interv Neuroradiol","first-page":"317","article-title":"Symptomatic occipital-vertebral anastomosis\u2014a case report","volume":"6","author":"Harada","year":"2000","unstructured":"Harada JKuwayama NNishijima MOkamoto SKubo MEndo S.Symptomatic occipital-vertebral anastomosis\u2014a case report. Interv Neuroradiol. 2000;6(4):317-320."},{"issue":"1","key":"bib10","series-title":"No To Shinkei","first-page":"69","article-title":"The developmental mechanism of occipital-vertebral anastomosis (author\u2019s transl)","volume":"32","author":"Suzuki","year":"1980","unstructured":"Suzuki SKuwabara YKarasawa S.The developmental mechanism of occipital-vertebral anastomosis (author\u2019s transl). Article in Japanese. No To Shinkei. 1980;32(1):69-79."},{"issue":"1","key":"bib11","series-title":"Neuroradiology","first-page":"31","article-title":"The occipital artery. 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World Neurosurg. 2017;102:693.e15-693.e19."},{"issue":"6","key":"bib19","series-title":"J Vasc Surg","first-page":"1127","article-title":"Initial evaluation of carotid angioplasty and stenting with three different cerebral protection devices","volume":"32","author":"Parodi","year":"2000","unstructured":"Parodi JCLa Mura RFerreira LMInitial evaluation of carotid angioplasty and stenting with three different cerebral protection devices. J Vasc Surg. 2000;32(6):1127-1136."},{"issue":"2","key":"bib1","series-title":"Zentralbl Neurochir","first-page":"76","article-title":"Zur Frage der Anastomosen zwischen der A. vertebralis und der A. occipitalis","volume":"16","author":"Schulze","year":"1956","unstructured":"Schulze HASauerbrey A.Zur Frage der Anastomosen zwischen der A. vertebralis und der A. occipitalis. 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Surg Neurol. 1985;24(2):160-164."},{"issue":"6","key":"bib5","series-title":"J Neurosurg","first-page":"849","article-title":"Spontaneous opening of large occipital-vertebral artery anastomosis during embolization. Case report","volume":"53","author":"Spetzler","year":"1980","unstructured":"Spetzler RFModic MBonstelle C.Spontaneous opening of large occipital-vertebral artery anastomosis during embolization. Case report. J Neurosurg. 1980;53(6):849-850."},{"issue":"1","key":"bib6","series-title":"AJNR Am J Neuroradiol","first-page":"71","article-title":"Extra- to intracranial arterial anastomoses in therapeutic embolization: recognition and role","volume":"1","author":"Ahn","year":"1980","unstructured":"Ahn HSKerber CWDeeb ZL.Extra- to intracranial arterial anastomoses in therapeutic embolization: recognition and role. AJNR Am J Neuroradiol. 1980;1(1):71-75."},{"issue":"7","key":"bib7","series-title":"J Med Assoc Thai","first-page":"426","article-title":"Posterior fossa stroke in a patient undergoing embolization of occipital artery: a case report","volume":"70","author":"Issaragrisl","year":"1987","unstructured":"Issaragrisl RBhoopat WKanpittaya C.Posterior fossa stroke in a patient undergoing embolization of occipital artery: a case report. J Med Assoc Thai. 1987;70(7):426-430."},{"issue":"2","key":"bib8","series-title":"Interv Neuroradiol","first-page":"212","article-title":"Carotid artery stenting for patients with occipital-vertebral anastomosis","volume":"25","author":"Kajikawa","year":"2019","unstructured":"Kajikawa RFujinaka TNakamura HKinoshita MNishida TKishima H.Carotid artery stenting for patients with occipital-vertebral anastomosis. Interv Neuroradiol. 2019;25(2):212-218."},{"issue":"4","key":"bib9","series-title":"Interv Neuroradiol","first-page":"317","article-title":"Symptomatic occipital-vertebral anastomosis\u2014a case report","volume":"6","author":"Harada","year":"2000","unstructured":"Harada JKuwayama NNishijima MOkamoto SKubo MEndo S.Symptomatic occipital-vertebral anastomosis\u2014a case report. Interv Neuroradiol. 2000;6(4):317-320."},{"issue":"1","key":"bib10","series-title":"No To Shinkei","first-page":"69","article-title":"The developmental mechanism of occipital-vertebral anastomosis (author\u2019s transl)","volume":"32","author":"Suzuki","year":"1980","unstructured":"Suzuki SKuwabara YKarasawa S.The developmental mechanism of occipital-vertebral anastomosis (author\u2019s transl). Article in Japanese. No To Shinkei. 1980;32(1):69-79."},{"issue":"1","key":"bib11","series-title":"Neuroradiology","first-page":"31","article-title":"The occipital artery. Anatomy\u2014normal arteriographic aspects\u2014embryological significance","volume":"15","author":"Lasjaunias","year":"1978","unstructured":"Lasjaunias PTh\u00e9ron JMoret J.The occipital artery. Anatomy\u2014normal arteriographic aspects\u2014embryological significance. Neuroradiology. 1978;15(1):31-37."},{"issue":"1","key":"bib12","series-title":"Neurosurgery","first-page":"ONS114","article-title":"The occipital artery: a microanatomical study","volume":"58","author":"Alvernia","year":"2006","unstructured":"Alvernia JEFraser KLanzino G.The occipital artery: a microanatomical study. Neurosurgery. 2006;58(1)(suppl):ONS114-22."},{"issue":"5","key":"bib13","series-title":"Surg Neurol","first-page":"350","article-title":"The occipital-vertebral anastomosis as a collateral pathway: hemodynamic patterns\u2014case report","volume":"32","author":"Miyachi","year":"1989","unstructured":"Miyachi SNegoro MSugita K.The occipital-vertebral anastomosis as a collateral pathway: hemodynamic patterns\u2014case report. Surg Neurol. 1989;32(5):350-355."},{"key":"bib14","series-title":"Pol J Radiol","first-page":"e126","article-title":"Bilateral thalamic stroke after tonsillectomy in a patient with collateral extracranial anastomosis\u2014case report","volume":"84","author":"Milnerowicz","year":"2019","unstructured":"Milnerowicz MGarcarek JBladowska JMi\u015b MMilnerowicz AS\u0105siadek M.Bilateral thalamic stroke after tonsillectomy in a patient with collateral extracranial anastomosis\u2014case report. Pol J Radiol. 2019;84:e126-e130."},{"issue":"11","key":"bib15","series-title":"Neurol Med Chir (Tokyo)","first-page":"1001","article-title":"Protection of anastomotic pathways to the vertebral artery during stenting of external carotid artery stenosis","volume":"50","author":"Yamagata","year":"2010","unstructured":"Yamagata TMitsuhashi YNishio AProtection of anastomotic pathways to the vertebral artery during stenting of external carotid artery stenosis. Neurol Med Chir (Tokyo). 2010;50(11):1001-1005."},{"issue":"6","key":"bib16","series-title":"Stroke","first-page":"711","article-title":"North American Symptomatic Carotid Endarterectomy Trial. Methods, patient characteristics, and progress","volume":"22","year":"1991","unstructured":"North American Symptomatic Carotid Endarterectomy Trial. Methods, patient characteristics, and progress. 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