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Related Experiment Videos

Common brachiocephalic trunk: strategies for revascularization.

A Azakie1, D B McElhinney, L M Messina

  • 1Division of Vascular Surgery, University of California, San Francisco 94143-0222, USA.

The Annals of Thoracic Surgery
|April 24, 1999
PubMed
Summary

Revascularization effectively treats occlusive disease of the common brachiocephalic trunk, a variant affecting 10% of people. Surgical options like bypass grafts or endarterectomy offer durable symptom relief but carry risks of neurological complications.

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Area of Science:

  • Vascular Surgery
  • Cerebrovascular Disease
  • Aortic Arch Anatomy

Background:

  • Common brachiocephalic trunk (CBT) is a normal aortic arch variant in ~10% of the population.
  • CBT supplies major cerebral blood flow; stenosis/occlusion causes severe ischemia.
  • Limited data exists on managing occlusive CBT disease.

Purpose of the Study:

  • To review management options for occlusive disease of the common brachiocephalic trunk.
  • To evaluate the efficacy and durability of revascularization procedures for CBT occlusive disease.

Main Methods:

  • Retrospective review of 6 patients with symptomatic CBT occlusion or stenosis (1977-1997).
  • Revascularization via ascending aorta to innominate/carotid bypass (n=5) or endarterectomy (n=1).

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  • Underlying causes included atherosclerosis (n=5) and Takayasu's arteritis (n=1).

    • Main Results:

    • One perioperative death (myocardial infarction) and one stroke.
    • One case of cerebral hyperperfusion syndrome resolved with medication.
    • Long-term follow-up (1-20 years) showed no symptomatic recurrence in survivors.

    Conclusions:

    • Revascularization using bypass grafts or endarterectomy provides effective symptom relief for occlusive CBT disease.
    • Neurologic complications, including one fatality, highlight the risks associated with CBT occlusive disease and its treatment.