{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T11:07:52Z","timestamp":1779361672148,"version":"3.51.4"},"reference-count":24,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"19","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"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":[[2026,5,11]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>In the endovascular treatment of symptomatic severe vertebral artery (VA) stenosis without collateral blood flow, intraprocedural acute occlusion due to thrombus rupture or lesion dissection can result in catastrophic ischemic complications in the posterior circulation. In this report, the authors describe an intentional staged angioplasty approach in which bypass surgery was performed before percutaneous transluminal angioplasty (PTA) at the stenotic lesion. This \u201csafety bypass\u201d was expected to provide distal collateral flow for inadvertent occlusion of the basilar artery due to dissection at the expanded segment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS\u2002<\/jats:title>\n                    <jats:p>A 59-year-old man presented with severe disturbance of consciousness and stenosis of the right VA. No posterior communicating arteries or collateral flow from the contralateral VA were identified on MR angiography. The authors performed a left superficial temporal artery\u2013superior cerebellar artery bypass in the first stage to ensure blood flow during temporary basilar artery occlusion and PTA at the stenotic lesion in the second stage of treatment. No new cerebral infarction or cerebral contusion occurred after the two procedures, and the patient was transferred to a rehabilitation facility.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>When the therapeutic risk is considered high in revascularization procedures for symptomatic intracranial vascular stenosis, intentional staged angioplasty with safety bypass is a viable option.<\/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\/CASE25957\">https:\/\/thejns.org\/doi\/10.3171\/CASE25957<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25957","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T16:15:35Z","timestamp":1778516135000},"source":"Crossref","is-referenced-by-count":0,"title":["Intentional staged angioplasty with superficial temporal artery\u2013superior cerebellar artery \u201csafety bypass\u201d for symptomatic severe vertebral artery stenosis: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1997-1125","authenticated-orcid":true,"given":"Masahiro","family":"Indo","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Higashi Yamato Hospital, Higashi Yamato, Tokyo"},{"name":"Department of Neurosurgery, International University of Health and Welfare Narita Hospital, Narita, Chiba"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Soichi","family":"Oya","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shinsuke","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masaaki","family":"Shojima","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Teikyo University Hospital, Itabashi-Ku, Tokyo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7513-7517","authenticated-orcid":true,"given":"Shigeru","family":"Nemoto","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kanto Rosai Hospital, Kanagawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akira","family":"Matsuno","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, International University of Health and Welfare Narita Hospital, Narita, Chiba"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"1","key":"bib1","series-title":"Acta Neurochir (Wien)","first-page":"77","article-title":"Clinical significance of STA-MCA double anastomosis for hemodynamic compromise in post-JET\/COSS era","volume":"156","author":"Kuroda","year":"2014","unstructured":"Kuroda SKawabori MHirata KClinical significance of STA-MCA double anastomosis for hemodynamic compromise in post-JET\/COSS era. Acta Neurochir (Wien). 2014;156(1):77-83. doi:10.1007\/s00701-013-1961-0"},{"issue":"9914","key":"bib2","series-title":"Lancet","first-page":"333","article-title":"Aggressive medical treatment with or without stenting in high-risk patients with intracranial artery stenosis (SAMMPRIS): the final results of a randomised trial","volume":"383","author":"Derdeyn","year":"2014","unstructured":"Derdeyn CPChimowitz MILynn MJAggressive medical treatment with or without stenting in high-risk patients with intracranial artery stenosis (SAMMPRIS): the final results of a randomised trial. Lancet. 2014;383(9914):333-341. doi:10.1016\/S0140-6736(13)62038-3"},{"issue":"18","key":"bib3","series-title":"JAMA","first-page":"1983","article-title":"Extracranial-intracranial bypass surgery for stroke prevention in hemodynamic cerebral ischemia: the Carotid Occlusion Surgery Study randomized trial","volume":"306","author":"Powers","year":"2011","unstructured":"Powers WJClarke WRGrubb RLJrExtracranial-intracranial bypass surgery for stroke prevention in hemodynamic cerebral ischemia: the Carotid Occlusion Surgery Study randomized trial. JAMA. 2011;306(18):1983-1992. doi:10.1001\/jama.2011.1610"},{"issue":"10","key":"bib4","series-title":"Lancet Neurol","first-page":"989","article-title":"Posterior circulation ischaemic stroke and transient ischaemic attack: diagnosis, investigation, and secondary prevention","volume":"12","author":"Markus","year":"2013","unstructured":"Markus HSvan der Worp HBRothwell PM.Posterior circulation ischaemic stroke and transient ischaemic attack: diagnosis, investigation, and secondary prevention. Lancet Neurol. 2013;12(10):989-998. doi:10.1016\/S1474-4422(13)70211-4"},{"issue":"3","key":"bib5","series-title":"Cureus","first-page":"e56479","article-title":"Endovascular approach in treating vertebrobasilar insufficiency: a systematic review","volume":"16","author":"Awawdeh","year":"2024","unstructured":"Awawdeh FSoti V.Endovascular approach in treating vertebrobasilar insufficiency: a systematic review. Cureus. 2024;16(3):e56479. doi:10.7759\/cureus.56479"},{"issue":"2","key":"bib6","series-title":"Stroke Vasc Neurol","first-page":"e003224","article-title":"Percutaneous transluminal angioplasty and stenting (PTAS) in patients with symptomatic intracranial vertebrobasilar artery stenosis (IVBS)","volume":"10","author":"Pourahmad","year":"2025","unstructured":"Pourahmad RSaleki KZoghi SPercutaneous transluminal angioplasty and stenting (PTAS) in patients with symptomatic intracranial vertebrobasilar artery stenosis (IVBS). Stroke Vasc Neurol. 2025;10(2):e003224. doi:10.1136\/svn-2024-003224"},{"issue":"3","key":"bib7","series-title":"Clin Neuroradiol","first-page":"435","article-title":"Revascularization techniques for acute basilar artery occlusion: technical considerations and outcome in the setting of severe posterior circulation steno-occlusive disease","volume":"29","author":"Siebert","year":"2019","unstructured":"Siebert EBohner GZweynert SRevascularization techniques for acute basilar artery occlusion: technical considerations and outcome in the setting of severe posterior circulation steno-occlusive disease. Clin Neuroradiol. 2019;29(3):435-443. doi:10.1007\/s00062-018-0683-3"},{"issue":"3","key":"bib8","series-title":"Stroke","first-page":"598","article-title":"Stroke risk after posterior circulation stroke\/transient ischemic attack and its relationship to site of vertebrobasilar stenosis: pooled data analysis from prospective studies","volume":"44","author":"Gulli","year":"2013","unstructured":"Gulli GMarquardt LRothwell PMMarkus HS.Stroke risk after posterior circulation stroke\/transient ischemic attack and its relationship to site of vertebrobasilar stenosis: pooled data analysis from prospective studies. 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Acta Neurochir (Wien). 2014;156(1):77-83. doi:10.1007\/s00701-013-1961-0"},{"issue":"9914","key":"bib2","series-title":"Lancet","first-page":"333","article-title":"Aggressive medical treatment with or without stenting in high-risk patients with intracranial artery stenosis (SAMMPRIS): the final results of a randomised trial","volume":"383","author":"Derdeyn","year":"2014","unstructured":"Derdeyn CPChimowitz MILynn MJAggressive medical treatment with or without stenting in high-risk patients with intracranial artery stenosis (SAMMPRIS): the final results of a randomised trial. Lancet. 2014;383(9914):333-341. doi:10.1016\/S0140-6736(13)62038-3"},{"issue":"18","key":"bib3","series-title":"JAMA","first-page":"1983","article-title":"Extracranial-intracranial bypass surgery for stroke prevention in hemodynamic cerebral ischemia: the Carotid Occlusion Surgery Study randomized trial","volume":"306","author":"Powers","year":"2011","unstructured":"Powers WJClarke WRGrubb RLJrExtracranial-intracranial bypass surgery for stroke prevention in hemodynamic cerebral ischemia: the Carotid Occlusion Surgery Study randomized trial. JAMA. 2011;306(18):1983-1992. doi:10.1001\/jama.2011.1610"},{"issue":"10","key":"bib4","series-title":"Lancet Neurol","first-page":"989","article-title":"Posterior circulation ischaemic stroke and transient ischaemic attack: diagnosis, investigation, and secondary prevention","volume":"12","author":"Markus","year":"2013","unstructured":"Markus HSvan der Worp HBRothwell PM.Posterior circulation ischaemic stroke and transient ischaemic attack: diagnosis, investigation, and secondary prevention. Lancet Neurol. 2013;12(10):989-998. doi:10.1016\/S1474-4422(13)70211-4"},{"issue":"3","key":"bib5","series-title":"Cureus","first-page":"e56479","article-title":"Endovascular approach in treating vertebrobasilar insufficiency: a systematic review","volume":"16","author":"Awawdeh","year":"2024","unstructured":"Awawdeh FSoti V.Endovascular approach in treating vertebrobasilar insufficiency: a systematic review. Cureus. 2024;16(3):e56479. doi:10.7759\/cureus.56479"},{"issue":"2","key":"bib6","series-title":"Stroke Vasc Neurol","first-page":"e003224","article-title":"Percutaneous transluminal angioplasty and stenting (PTAS) in patients with symptomatic intracranial vertebrobasilar artery stenosis (IVBS)","volume":"10","author":"Pourahmad","year":"2025","unstructured":"Pourahmad RSaleki KZoghi SPercutaneous transluminal angioplasty and stenting (PTAS) in patients with symptomatic intracranial vertebrobasilar artery stenosis (IVBS). Stroke Vasc Neurol. 2025;10(2):e003224. doi:10.1136\/svn-2024-003224"},{"issue":"3","key":"bib7","series-title":"Clin Neuroradiol","first-page":"435","article-title":"Revascularization techniques for acute basilar artery occlusion: technical considerations and outcome in the setting of severe posterior circulation steno-occlusive disease","volume":"29","author":"Siebert","year":"2019","unstructured":"Siebert EBohner GZweynert SRevascularization techniques for acute basilar artery occlusion: technical considerations and outcome in the setting of severe posterior circulation steno-occlusive disease. Clin Neuroradiol. 2019;29(3):435-443. doi:10.1007\/s00062-018-0683-3"},{"issue":"3","key":"bib8","series-title":"Stroke","first-page":"598","article-title":"Stroke risk after posterior circulation stroke\/transient ischemic attack and its relationship to site of vertebrobasilar stenosis: pooled data analysis from prospective studies","volume":"44","author":"Gulli","year":"2013","unstructured":"Gulli GMarquardt LRothwell PMMarkus HS.Stroke risk after posterior circulation stroke\/transient ischemic attack and its relationship to site of vertebrobasilar stenosis: pooled data analysis from prospective studies. Stroke. 2013;44(3):598-604. doi:10.1161\/STROKEAHA.112.669929"},{"issue":"9","key":"bib9","series-title":"Stroke","first-page":"1083","article-title":"The Lausanne Stroke Registry: analysis of 1,000 consecutive patients with first stroke","volume":"19","author":"Bogousslavsky","year":"1988","unstructured":"Bogousslavsky JVan Melle GRegli F.The Lausanne Stroke Registry: analysis of 1,000 consecutive patients with first stroke. Stroke. 1988;19(9):1083-1092. doi:10.1161\/01.STR.19.9.1083"},{"issue":"4","key":"bib10","series-title":"Neurology","first-page":"490","article-title":"Symptomatic intracranial atherosclerosis: outcome of patients who fail antithrombotic therapy","volume":"55","author":"Thijs","year":"2000","unstructured":"Thijs VNAlbers GW.Symptomatic intracranial atherosclerosis: outcome of patients who fail antithrombotic therapy. Neurology. 2000;55(4):490-497. doi:10.1212\/WNL.55.4.490"},{"issue":"suppl 1","key":"bib11","series-title":"Neurosurgery","first-page":"S102","article-title":"Advances and innovations in revascularization of extracranial vertebral artery","volume":"74","author":"Brasiliense","year":"2014","unstructured":"Brasiliense LBAlbuquerque FCSpetzler RFHanel RA.Advances and innovations in revascularization of extracranial vertebral artery. Neurosurgery. 2014;74(suppl 1):S102-S115. doi:10.1227\/NEU.0000000000000218"},{"issue":"8","key":"bib12","series-title":"JAMA","first-page":"704","article-title":"Extracranial-intracranial bypass and risk of stroke and death in patients with symptomatic artery occlusion: the CMOSS randomized clinical trial","volume":"330","author":"Ma","year":"2023","unstructured":"Ma YWang TWang HExtracranial-intracranial bypass and risk of stroke and death in patients with symptomatic artery occlusion: the CMOSS randomized clinical trial. JAMA. 2023;330(8):704-714. doi:10.1001\/jama.2023.13390"}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/11\/19\/article-CASE25957.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/11\/19\/article-CASE25957.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/11\/19\/article-CASE25957.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T10:39:58Z","timestamp":1779359998000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/11\/19\/article-CASE25957.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,11]]},"references-count":24,"journal-issue":{"issue":"19"},"URL":"https:\/\/doi.org\/10.3171\/case25957","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,11]]}}}