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Surgical Revascularisation of the Brain: A rare operation for unusual circumstances

Case Examples:

A 30 year-old woman suffered an injury to both carotid arteries, which are the blood vessels that supply most of the blood flow to both sides of the brain. The right carotid artery, although injured, was still patent (allowing blood to flow), but the left was completely occluded.  The patient was becoming progressively paralyzed on the right side of her body, and was unable to speak.

Pre-Treatment:

Angiogram of the left carotid artery in the neck (left panel) and the head (right panel), showing that the internal carotid artery is blocked (arrow), allowing no blood to get to the brain. 

   

Angiogram of the right carotid artery showing the injured segment in the neck (arrow; left panel). The right panel shows that the blood flow gets to the right side of the brain, but less so to the left side.

Intra-Treatment:

Surgeon's view of the operative site. There are two clips on the middle cerebral artery, and the vein has been sown into place.

   

All of the clips have now been removed, and the vein is filling with blood. Blood flow has been restored.

   

Treatment consisted of obtaining a vein from the patient's leg, and connecting one end of it to the left middle cerebral artery, one of the main arteries of the brain. The other  end of the vein was connected to the patient's caroted artery below the level of the injured segment.

Post-Treatment:

Angiogram of the left carotid artery showing blood flowing into the vein graft (arrow).

   

Angiogram of the blood vessels on the left side of the patient's brain, showing that they fill with blood through the vein graft (arrow)