Thyrocervical to vertebral artery transposition and ipsilateral carotid endarterectomy

Area of Science:

• Vascular Surgery
• Cerebrovascular Disease Management
• Interventional Neurology

Background:

• Symptomatic high-grade stenosis of the proximal vertebral artery (VA) and ipsilateral carotid artery (CA) presents a significant challenge in cerebrovascular disease.
• Patients may experience persistent posterior circulation ischemic neurological deficits despite standard anticoagulation therapy.

Observation:

• A patient with concurrent high-grade stenosis of the proximal right vertebral artery and ipsilateral carotid artery presented with recurrent ischemic events.
• Conservative management with anticoagulation failed to prevent further neurological deficits.

Findings:

• A single-stage surgical procedure involving carotid endarterectomy and thyrocervical-to-vertebral artery transposition was successfully performed.
• This combined approach effectively addressed both stenotic lesions in one operation.

Implications:

• This innovative technique offers advantages over traditional methods, particularly by avoiding additional carotid artery cross-clamping.
• The distinct anastomosis sites reduce the risk of simultaneous thrombosis, enhancing patient safety.
• This procedure represents a promising treatment option for complex cerebrovascular stenosis involving both the carotid and vertebral arteries.