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Subclavian Artery-Internal Carotid Artery Bypass Using a Radial Artery Graft for Common Carotid Artery Occlusion with
Kazuya Morita1, Tomoya Kamide1, Riho Nakajima1
1Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
Insights
Common carotid artery occlusion (CCAO) can cause stroke. A subclavian artery (SclA) to internal carotid artery (ICA) bypass using a radial artery graft (RAG) successfully restored function and prevented stroke in a patient.
Area of Science:
- Vascular Surgery
- Neurology
- Interventional Cardiology
Background:
- Common carotid artery occlusion (CCAO) is a rare condition causing ischemic neurological dysfunction.
- Revascularization is a potential treatment, but consensus on optimal surgical approaches and outcomes is lacking.
Observation:
- A 58-year-old male presented with recurrent right-sided weakness and multiple cerebral infarcts on MRI.
- Digital subtraction angiography confirmed left CCAO with absent flow in the left internal carotid artery (ICA) and external carotid artery.
- A left subclavian artery (SclA) to cervical ICA bypass was performed using a radial artery graft (RAG).
Findings:
- The SclA-ICA bypass using RAG resulted in immediate recovery of cognitive function.
- Postoperatively, the patient experienced no neurological deficits and improved cognitive function.
- The procedure successfully prevented further ischemic events.
Implications:
- Subclavian artery (SclA) to internal carotid artery (ICA) bypass with a radial artery graft (RAG) is a viable treatment for CCAO.
- Revascularization for CCAO can effectively prevent ischemic stroke and enhance cognitive function.
Introduction:
Although rare, common carotid artery occlusion (CCAO) causes ischemic neurological dysfunction, which can be treated by revascularization. Although several bypass approaches for CCAO have been suggested, no consensus on the surgical revascularization approach and its functional outcome have been reached. Herein, we present a case of Rile's type 1A CCAO in which a subclavian artery (SclA)-internal carotid artery (ICA) bypass using a radial artery graft (RAG) resulted in immediate recovery of cognitive function and successfully prevented ischemic stroke.
Case Description:
A 58-year-old man presented with recurrent episodes of right-sided weakness. Brain magnetic resonance imaging revealed multiple cerebral infarcts. Digital subtraction angiography confirmed left CCAO and no anterograde blood flow in the left ICA and ipsilateral external carotid artery. A bypass was performed from the left SclA to the left cervical ICA using a left RAG, and supraclavicular anastomosis between the SclA and ICA was performed without graft-vessel kinking. Postoperatively, no neurological deficits were observed, and his cognitive function was successfully improved.
Conclusion:
SclA-ICA bypass using an RAG can be a reasonable treatment option for CCAO. CCAO revascularization can prevent ischemic stroke and improve cognitive function.
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