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Bypass surgery for occluded internal carotid artery revascularized by vasa vasorum--case report
Hiroaki Shimizu1, Teiji Tominaga, Masayuki Ezura
1Department of Neurosurgery, Kohnan Hospital, Sendai. hshimizu@kohnan-sendai.or.jp
Insights
A patient with internal carotid artery occlusion, revascularized by vasa vasorum, underwent successful bypass surgery. This procedure restored blood flow, highlighting reconstructive surgery as a viable treatment option for such complex cases.
Area of Science:
- Vascular Surgery
- Neurology
- Interventional Radiology
Background:
- Internal carotid artery (ICA) occlusion can lead to transient ischemic attacks (TIAs).
- Vasa vasorum revascularization presents a unique challenge in managing ICA occlusive disease.
- Surgical intervention requires precise anatomical and hemodynamic assessment.
Observation:
- A 47-year-old female presented with TIAs secondary to left ICA occlusion.
- Angiography revealed occlusion of the left common carotid artery (CCA) including the ICA origin.
- The distal ICA was found to be revascularized by vasa vasorum.
Findings:
- Successful left subclavian artery-to-internal carotid artery bypass using a saphenous vein graft was performed.
- Intraoperative angiography confirmed a narrowed but patent lumen in the native ICA.
- Post-operative angiography demonstrated significant enlargement of the distal ICA post-bypass.
Implications:
- Reconstructive bypass surgery is a feasible treatment for patients with ICA occlusion revascularized by vasa vasorum.
- Pre-operative angiographic identification of the ICA lumen is crucial for surgical planning.
- This case underscores the importance of advanced imaging in guiding surgical revascularization strategies.
Abstract:
A 47-year-old woman presented with two transient ischemic attacks due to occlusion of the left internal carotid artery. The affected artery was revascularized by vasa vasorum. Angiography showed occlusion of the left common carotid artery including the origin of the internal carotid artery. The distal internal carotid artery was revascularized by vasa vasorum at the level of the second cervical vertebral body. Left subclavian artery-internal carotid artery bypass surgery using a saphenous vein graft was performed successfully, during which the narrowed but patent lumen of the internal carotid artery was confirmed. Follow-up angiography showed enlargement of the left internal carotid artery distal to the patent bypass. Reconstructive bypass surgery is a possible treatment for patients with occluded internal carotid artery revascularized by vasa vasorum. Angiographic detection of the lumen of the internal carotid artery is important for surgical consideration.