"Bonnet bypass" using a radial artery interposition graft-how I do it.

BACKGROUND

Common carotid artery (CCA) occlusion frequently results in compromised hemodynamics of the ipsilateral hemisphere with risk of infarction but also a lack of blood flow in the ipsilateral superficial temporal artery (STA), requiring a more complex revascularization strategy than a standard extracranial-intracranial (EC-IC) bypass when indicated.

METHOD: We describe the performance of a "Bonnet bypass" using a radial artery interposition graft (RAIG) from the contralateral STA to the ipsilateral middle cerebral artery (MCA). A groove is drilled in the skullcap to position the RAIG and reduce risk of mobilization and compression.

CONCLUSION

The "Bonnet bypass" enables a revascularization procedure when the ipsilateral STA is not available as donor vessel.