Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 26, 2023; 11(9): 2091-2097
Published online Mar 26, 2023. doi: 10.12998/wjcc.v11.i9.2091
Occipital artery bypass importance in unsuitable superficial temporal artery: Two case reports
Jong-Hwan Hong, Sung-Chan Jung, Han-Seung Ryu, Tae-Sun Kim, Sung-Pil Joo
Jong-Hwan Hong, Sung-Chan Jung, Han-Seung Ryu, Tae-Sun Kim, Sung-Pil Joo, Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju 61469, South Korea
Author contributions: Joo SP performed the operation and evaluated patients; Hong JH wrote the manuscript (first author); Joo SP and Kim TS provided writing assistance; Ryu HS and Jung SC evaluated and reviewed the chart.
Supported by a grant from Chonnam National University Hospital Biomedical Research Institute, No. BCRI22053.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no potential or actual conflicts of interest regarding this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised following the CARE Checklist (2016).
Open-Access: This is an open-access article selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution-Noncommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, and the use is non-commercial. See:
Corresponding author: Sung-Pil Joo, MD, PhD, Professor, Department of Neurosurgery, Chonnam National University Hospital and Medical School, Jebong-ro 42, Gwangju 61469, South Korea.
Received: December 24, 2022
Peer-review started: December 24, 2022
First decision: January 30, 2023
Revised: January 31, 2023
Accepted: February 27, 2023
Article in press: February 27, 2023
Published online: March 26, 2023

Superficial temporal artery-middle cerebral artery (STA-MCA) bypass helps treat cerebral ischemia. However, the STA is not available for bypass in some conditions. Therefore, with some technical tips, the authors introduced a bypass technique using the occipital artery (OA).


Two female patients complained of hemiparesis. Brain magnetic resonance imaging (MRI) indicated contralateral infarction from the MCA steno-occlusion. On Diamox single photon emission computed tomography or perfusion MRI, the contralateral front parietotemporal reserve was diminished. On transfemoral cerebral angiography, the STA was thin with a weak flow; however, the OA was prominent. Direct OA-MCA end-to-side extracranial-intracranial bypass surgery was implemented instead of STA because the caliber was too narrow. The postoperative course was uneventful in both cases, with well-maintained bypass patency and neurological stability during follow-up.


OA might be an acceptable alternative for MCA cerebral ischemic cases with an unsuitable STA.

Keywords: Bypass, Occipital artery, Superficial temporal artery, Cerebral ischemia, Case report

Core Tip: In cases of cerebral ischemic disease or progressive ischemia where the Superficial temporal artery is unsuitable in the middle cerebral artery territory, occipital artery might be an acceptable donor artery for a less invasive EC-IC bypass surgery.