[The subclavian-carotid bypass as a method for treating obstruction of the common carotid]

Common carotid artery occlusion is a relatively uncommon lesion (0.5-5% of patients with cerebral ischaemia). Cerebral revascularization is possible only in case of patent carotid bifurcation, three patients, all of them symptomatic (2 TIA's and 1 amaurosis fugax) with a complete common carotid artery occlusion have been treated with a subclavian-carotid artery by-pass (2 PTFE, 1 reversed saphenous vein). Among the patients one death occurred in the fourth postoperative day by bronchopneumonia, no stroke was detected, in the remaining two, the by-pass was patent one year and respectively three years post-operatively. In case of common carotid artery occlusion, visualization of bifurcation is usually better obtained through a color-duplex than arteriography. Several operations have been proposed in these patients (retrograde thrombectomy, carotid to carotid by-pass, carotid-subclavian reimplantation), but subclavian to carotid by-pass is the most safe and common used procedure.