{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T11:07:32Z","timestamp":1779361652703,"version":"3.51.4"},"reference-count":38,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"18","license":[{"start":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:00:00Z","timestamp":1777852800000},"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 Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,5,4]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Extracranial-intracranial revascularization has evolved to include bypasses using interposition grafts, most commonly the saphenous vein (SV) or radial artery (RA). These high-flow conduits are essential for treating giant or complex aneurysms, skull base tumors encasing the carotid or middle cerebral arteries, and selected cases of ischemic cerebrovascular disease requiring preservation or augmentation of cerebral blood flow.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>This report describes the first case of cerebral revascularization using the internal mammary artery (IMA) as an interposition graft. The patient had previously undergone endovascular treatment of an internal carotid artery aneurysm with a flow diverter and later developed progressive arterial stenosis leading to compromised distal cerebral perfusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>To achieve optimal outcomes and long-term patency, graft selection and bypass strategy must be planned meticulously, taking into consideration the patient\u2019s anatomy and specific clinical requirements. In the present case, because the RAs and SVs were unsuitable as primary grafts, the IMA was selected as a viable alternative for a high-capacitance internal maxillary artery\u2013middle cerebral artery bypass. The graft was harvested through a minimally invasive thoracoscopic approach. Postoperatively, the patient exhibited significant clinical improvement, and perfusion CT demonstrated restoration of cerebral blood flow.<\/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\/CASE25888\">https:\/\/thejns.org\/doi\/10.3171\/CASE25888<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25888","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T16:15:30Z","timestamp":1778516130000},"source":"Crossref","is-referenced-by-count":0,"title":["The internal mammary artery as an alternative graft for internal maxillary artery\u2013middle cerebral artery bypass: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"given":"Juan J.","family":"Ram\u00edrez-Andrade","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Hospital Puerta de Hierro Andares, Zapopan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Javier","family":"Degollado-Garc\u00eda","sequence":"additional","affiliation":[{"name":"Department of Vascular Neurosurgery, ISSEMYM, Toluca"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benigno","family":"Ferreira-Pi\u00f1a","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Minimal Invasive Cardiothoracic Surgery Institute, Zapopan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlos F.","family":"Nicol\u00e1s-Cruz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Instituto Nacional de Neurolog\u00eda y Neurocirug\u00eda \u201cManuel Velasco Su\u00e1rez,\u201d Mexico City, M\u00e9xico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. Tom\u00e1s","family":"Moncada-Habib","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Instituto Nacional de Neurolog\u00eda y Neurocirug\u00eda \u201cManuel Velasco Su\u00e1rez,\u201d Mexico City, M\u00e9xico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco Antonio","family":"Mu\u00f1uzuri-Camacho","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Instituto Nacional de Neurolog\u00eda y Neurocirug\u00eda \u201cManuel Velasco Su\u00e1rez,\u201d Mexico City, M\u00e9xico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5436-5900","authenticated-orcid":true,"given":"Zahira Elizabeth","family":"Medina-Felix","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Instituto Nacional de Neurolog\u00eda y Neurocirug\u00eda \u201cManuel Velasco Su\u00e1rez,\u201d Mexico City, M\u00e9xico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edgar","family":"Nathal","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Instituto Nacional de Neurolog\u00eda y Neurocirug\u00eda \u201cManuel Velasco Su\u00e1rez,\u201d Mexico City, M\u00e9xico"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"bib1","series-title":"Microsurgery Applied to Neurosurgery","first-page":"95","article-title":"Diagnosis and indications for operations in cerebrovascular occlusive disease.","author":"Ya\u015fargil","year":"1969","unstructured":"Ya\u015fargil MG.Diagnosis and indications for operations in cerebrovascular occlusive disease. In: Microsurgery Applied to Neurosurgery. Georg Thieme Verlag, Academic Press; 1969:95-118."},{"issue":"1","key":"bib2","series-title":"J Neurosurg","first-page":"22","article-title":"Elective extracranial-intracranial arterial bypass in the treatment of inoperable giant aneurysms of the internal carotid artery","volume":"53","author":"Spetzler","year":"1980","unstructured":"Spetzler RFSchuster HRoski RA.Elective extracranial-intracranial arterial bypass in the treatment of inoperable giant aneurysms of the internal carotid artery. J Neurosurg. 1980;53(1):22-27. doi:10.3171\/jns.1980.53.1.0022"},{"issue":"8","key":"bib3","series-title":"Acta Neurochir (Wien)","first-page":"1517","article-title":"Reconstruction of intracranial vertebral artery with radial artery and occipital artery grafts for fusiform intracranial vertebral aneurysm not amenable to endovascular treatment: technical note","volume":"155","author":"Kubota","year":"2013","unstructured":"Kubota HTanikawa RKatsuno MReconstruction of intracranial vertebral artery with radial artery and occipital artery grafts for fusiform intracranial vertebral aneurysm not amenable to endovascular treatment: technical note. Acta Neurochir (Wien). 2013;155(8):1517-1524. doi:10.1007\/s00701-013-1715-z"},{"issue":"1","key":"bib4","series-title":"J Neurosurg","first-page":"138","article-title":"Cervical-to-petrous internal carotid artery bypass procedure. 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J Neurosurg. 1990;73(4):496-501. doi:10.3171\/jns.1990.73.4.0496"},{"issue":"6","key":"bib6","series-title":"Neurosurgery","first-page":"1207","article-title":"Venous and arterial bypass grafts for difficult tumors, aneurysms, and occlusive vascular lesions: evolution of surgical treatment and improved graft results","volume":"44","author":"Sekhar","year":"1999","unstructured":"Sekhar LNBucur SDBank WOWright DC.Venous and arterial bypass grafts for difficult tumors, aneurysms, and occlusive vascular lesions: evolution of surgical treatment and improved graft results. 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J Am Coll Cardiol. 2004;44(11):2149-2156. doi:10.1016\/j.jacc.2004.08.064"},{"issue":"4","key":"bib9","series-title":"J Thorac Cardiovasc Surg","first-page":"1293","article-title":"Long-term observational angiographic patency and perfect patency of radial artery compared with saphenous vein or internal mammary artery in coronary bypass surgery","volume":"167","author":"Ren","year":"2024","unstructured":"Ren JRoyse CSiderakis CSrivastav NRoyse A.Long-term observational angiographic patency and perfect patency of radial artery compared with saphenous vein or internal mammary artery in coronary bypass surgery. 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Surg Technol Int. 2004;13:199-205."},{"issue":"4","key":"bib12","series-title":"Ann Thorac Surg","first-page":"1036","article-title":"Catheter-assisted totally thoracoscopic coronary artery bypass grafting: a feasibility study","volume":"64","author":"Soulez","year":"1997","unstructured":"Soulez GGagner MTherasse ECatheter-assisted totally thoracoscopic coronary artery bypass grafting: a feasibility study. Ann Thorac Surg. 1997;64(4):1036-1040. doi:10.1016\/S0003-4975(97)00719-4"},{"issue":"6","key":"bib13","series-title":"Ann Thorac Surg","first-page":"S104","article-title":"Thoracoscopic internal mammary artery harvesting: technical considerations","volume":"63","author":"Nataf","year":"1997","unstructured":"Nataf PLima LRegan MThoracoscopic internal mammary artery harvesting: technical considerations. Ann Thorac Surg. 1997;63(6)(suppl):S104-S106. doi:10.1016\/S0003-4975(97)00420-7"},{"issue":"1","key":"bib14","series-title":"J Cerebrovasc Endovasc Neurosurg","first-page":"51","article-title":"Internal maxillary artery (Imax)\u2014middle cerebral artery bypass in a patient with bilateral atherosclerotic carotid occlusion: a technical case report","volume":"26","author":"Degollado-Garc\u00eda","year":"2024","unstructured":"Degollado-Garc\u00eda JCasas-Mart\u00ednez MRMejia BRFBalc\u00e1zar-Padr\u00f3n JCRodr\u00edguez-Rubio HANathal E.Internal maxillary artery (Imax)\u2014middle cerebral artery bypass in a patient with bilateral atherosclerotic carotid occlusion: a technical case report. J Cerebrovasc Endovasc Neurosurg. 2024;26(1):51-57. doi:10.7461\/jcen.2023.E2022.11.003"},{"issue":"3","key":"bib15","series-title":"J Thorac Cardiovasc Surg","first-page":"414","article-title":"Selection of coronary bypass. Anatomic, physiological, and angiographic considerations of vein and mammary artery grafts","volume":"70","author":"Geha","year":"1975","unstructured":"Geha ASKrone RJMcCormick JRBaue AE.Selection of coronary bypass. Anatomic, physiological, and angiographic considerations of vein and mammary artery grafts. J Thorac Cardiovasc Surg. 1975;70(3):414-431. doi:10.1016\/S0022-5223(19)40315-2"},{"issue":"1","key":"bib16","series-title":"BMC Cardiovasc Disord","first-page":"148","article-title":"Patency of conduits in patients who received internal mammary artery, radial artery and saphenous vein grafts","volume":"20","author":"Royse","year":"2020","unstructured":"Royse APamment WPawanis ZPatency of conduits in patients who received internal mammary artery, radial artery and saphenous vein grafts. BMC Cardiovasc Disord. 2020;20(1):148. doi:10.1186\/s12872-020-01433-0"},{"issue":"6","key":"bib17","series-title":"Ann Thorac Surg","first-page":"628","article-title":"Intimal hyperplasia. A cause of radial artery aortocoronary bypass graft failure","volume":"20","author":"Curtis","year":"1975","unstructured":"Curtis JJStoney WSAlford WCBurrus GRThomas CS.Intimal hyperplasia. A cause of radial artery aortocoronary bypass graft failure. Ann Thorac Surg. 1975;20(6):628-635. doi:10.1016\/S0003-4975(10)65754-2"},{"issue":"1","key":"bib18","series-title":"J Neurosurg","first-page":"40","article-title":"The evolution and future directions of bypass surgery","volume":"142","author":"Enriquez-Marulanda","year":"2025","unstructured":"Enriquez-Marulanda ARamirez-Velandia FYoung MThe evolution and future directions of bypass surgery. J Neurosurg. 2025;142(1):40-51. doi:10.3171\/2024.4.JNS2419"},{"issue":"20","key":"bib19","series-title":"Int J Mol Sci","first-page":"10053","article-title":"Molecular targets for intracranial aneurysm treatment","volume":"26","author":"Hutchinson","year":"2025","unstructured":"Hutchinson HRezk RFarag MHanna ALucke-Wold B.Molecular targets for intracranial aneurysm treatment. Int J Mol Sci. 2025;26(20):10053. doi:10.3390\/ijms262010053"},{"key":"bib1","series-title":"Microsurgery Applied to Neurosurgery","first-page":"95","article-title":"Diagnosis and indications for operations in cerebrovascular occlusive disease.","author":"Ya\u015fargil","year":"1969","unstructured":"Ya\u015fargil MG.Diagnosis and indications for operations in cerebrovascular occlusive disease. In: Microsurgery Applied to Neurosurgery. Georg Thieme Verlag, Academic Press; 1969:95-118."},{"issue":"1","key":"bib2","series-title":"J Neurosurg","first-page":"22","article-title":"Elective extracranial-intracranial arterial bypass in the treatment of inoperable giant aneurysms of the internal carotid artery","volume":"53","author":"Spetzler","year":"1980","unstructured":"Spetzler RFSchuster HRoski RA.Elective extracranial-intracranial arterial bypass in the treatment of inoperable giant aneurysms of the internal carotid artery. J Neurosurg. 1980;53(1):22-27. doi:10.3171\/jns.1980.53.1.0022"},{"issue":"8","key":"bib3","series-title":"Acta Neurochir (Wien)","first-page":"1517","article-title":"Reconstruction of intracranial vertebral artery with radial artery and occipital artery grafts for fusiform intracranial vertebral aneurysm not amenable to endovascular treatment: technical note","volume":"155","author":"Kubota","year":"2013","unstructured":"Kubota HTanikawa RKatsuno MReconstruction of intracranial vertebral artery with radial artery and occipital artery grafts for fusiform intracranial vertebral aneurysm not amenable to endovascular treatment: technical note. Acta Neurochir (Wien). 2013;155(8):1517-1524. doi:10.1007\/s00701-013-1715-z"},{"issue":"1","key":"bib4","series-title":"J Neurosurg","first-page":"138","article-title":"Cervical-to-petrous internal carotid artery bypass procedure. Technical note","volume":"79","author":"Fitzpatrick","year":"1993","unstructured":"Fitzpatrick BCSpetzler RFBallard JLZimmerman RS.Cervical-to-petrous internal carotid artery bypass procedure. Technical note. J Neurosurg. 1993;79(1):138-141. doi:10.3171\/jns.1993.79.1.0138"},{"issue":"4","key":"bib5","series-title":"J Neurosurg","first-page":"496","article-title":"Petrous carotid-to-intradural carotid saphenous vein graft for intracavernous giant aneurysm, tumor, and occlusive cerebrovascular disease","volume":"73","author":"Spetzler","year":"1990","unstructured":"Spetzler RFFukushima TMartin NZabramski JM.Petrous carotid-to-intradural carotid saphenous vein graft for intracavernous giant aneurysm, tumor, and occlusive cerebrovascular disease. J Neurosurg. 1990;73(4):496-501. doi:10.3171\/jns.1990.73.4.0496"},{"issue":"6","key":"bib6","series-title":"Neurosurgery","first-page":"1207","article-title":"Venous and arterial bypass grafts for difficult tumors, aneurysms, and occlusive vascular lesions: evolution of surgical treatment and improved graft results","volume":"44","author":"Sekhar","year":"1999","unstructured":"Sekhar LNBucur SDBank WOWright DC.Venous and arterial bypass grafts for difficult tumors, aneurysms, and occlusive vascular lesions: evolution of surgical treatment and improved graft results. Neurosurgery. 1999;44(6):1207-1223. doi:10.1097\/00006123-199906000-00028"},{"issue":"2","key":"bib7","series-title":"Skull Base","first-page":"119","article-title":"Revascularization with saphenous vein bypasses for complex intracranial aneurysms","volume":"15","author":"Qui\u00f1ones-Hinojosa","year":"2005","unstructured":"Qui\u00f1ones-Hinojosa ADu RLawton MT.Revascularization with saphenous vein bypasses for complex intracranial aneurysms. Skull Base. 2005;15(2):119-132. doi:10.1055\/s-2005-870598"},{"issue":"11","key":"bib8","series-title":"J Am Coll Cardiol","first-page":"2149","article-title":"Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery: results from a Department of Veterans Affairs Cooperative Study","volume":"44","author":"Goldman","year":"2004","unstructured":"Goldman SZadina KMoritz TLong-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery: results from a Department of Veterans Affairs Cooperative Study. J Am Coll Cardiol. 2004;44(11):2149-2156. doi:10.1016\/j.jacc.2004.08.064"},{"issue":"4","key":"bib9","series-title":"J Thorac Cardiovasc Surg","first-page":"1293","article-title":"Long-term observational angiographic patency and perfect patency of radial artery compared with saphenous vein or internal mammary artery in coronary bypass surgery","volume":"167","author":"Ren","year":"2024","unstructured":"Ren JRoyse CSiderakis CSrivastav NRoyse A.Long-term observational angiographic patency and perfect patency of radial artery compared with saphenous vein or internal mammary artery in coronary bypass surgery. J Thorac Cardiovasc Surg. 2024;167(4):1293-1302.e4. doi:10.1016\/j.jtcvs.2022.08.047"},{"issue":"11","key":"bib10","series-title":"Circulation","first-page":"II36","article-title":"Long-term patency of internal mammary artery bypass grafts: relationship with preoperative severity of the native coronary artery stenosis","volume":"110","author":"Berger","year":"2004","unstructured":"Berger AMacCarthy PASiebert ULong-term patency of internal mammary artery bypass grafts: relationship with preoperative severity of the native coronary artery stenosis. Circulation. 2004;110(11)(suppl 1):II36-II40. doi:10.1161\/01.CIR.0000141256.05740.69"},{"key":"bib11","series-title":"Surg Technol Int","first-page":"199","article-title":"Benefits and complications of total sternotomy and ministernotomy in cardiac surgery","volume":"13","author":"Farhat","year":"2004","unstructured":"Farhat FMetton OJegaden O.Benefits and complications of total sternotomy and ministernotomy in cardiac surgery. Surg Technol Int. 2004;13:199-205."},{"issue":"4","key":"bib12","series-title":"Ann Thorac Surg","first-page":"1036","article-title":"Catheter-assisted totally thoracoscopic coronary artery bypass grafting: a feasibility study","volume":"64","author":"Soulez","year":"1997","unstructured":"Soulez GGagner MTherasse ECatheter-assisted totally thoracoscopic coronary artery bypass grafting: a feasibility study. Ann Thorac Surg. 1997;64(4):1036-1040. doi:10.1016\/S0003-4975(97)00719-4"},{"issue":"6","key":"bib13","series-title":"Ann Thorac Surg","first-page":"S104","article-title":"Thoracoscopic internal mammary artery harvesting: technical considerations","volume":"63","author":"Nataf","year":"1997","unstructured":"Nataf PLima LRegan MThoracoscopic internal mammary artery harvesting: technical considerations. Ann Thorac Surg. 1997;63(6)(suppl):S104-S106. doi:10.1016\/S0003-4975(97)00420-7"},{"issue":"1","key":"bib14","series-title":"J Cerebrovasc Endovasc Neurosurg","first-page":"51","article-title":"Internal maxillary artery (Imax)\u2014middle cerebral artery bypass in a patient with bilateral atherosclerotic carotid occlusion: a technical case report","volume":"26","author":"Degollado-Garc\u00eda","year":"2024","unstructured":"Degollado-Garc\u00eda JCasas-Mart\u00ednez MRMejia BRFBalc\u00e1zar-Padr\u00f3n JCRodr\u00edguez-Rubio HANathal E.Internal maxillary artery (Imax)\u2014middle cerebral artery bypass in a patient with bilateral atherosclerotic carotid occlusion: a technical case report. J Cerebrovasc Endovasc Neurosurg. 2024;26(1):51-57. doi:10.7461\/jcen.2023.E2022.11.003"},{"issue":"3","key":"bib15","series-title":"J Thorac Cardiovasc Surg","first-page":"414","article-title":"Selection of coronary bypass. Anatomic, physiological, and angiographic considerations of vein and mammary artery grafts","volume":"70","author":"Geha","year":"1975","unstructured":"Geha ASKrone RJMcCormick JRBaue AE.Selection of coronary bypass. Anatomic, physiological, and angiographic considerations of vein and mammary artery grafts. J Thorac Cardiovasc Surg. 1975;70(3):414-431. doi:10.1016\/S0022-5223(19)40315-2"},{"issue":"1","key":"bib16","series-title":"BMC Cardiovasc Disord","first-page":"148","article-title":"Patency of conduits in patients who received internal mammary artery, radial artery and saphenous vein grafts","volume":"20","author":"Royse","year":"2020","unstructured":"Royse APamment WPawanis ZPatency of conduits in patients who received internal mammary artery, radial artery and saphenous vein grafts. BMC Cardiovasc Disord. 2020;20(1):148. doi:10.1186\/s12872-020-01433-0"},{"issue":"6","key":"bib17","series-title":"Ann Thorac Surg","first-page":"628","article-title":"Intimal hyperplasia. 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