Related Experiment Video

Updated: Aug 5, 2026

Bilateral Common Carotid Artery Occlusion as an Adequate Preconditioning Stimulus to Induce Early Ischemic Tolerance to Focal Cerebral Ischemia
07:46

Bilateral Common Carotid Artery Occlusion as an Adequate Preconditioning Stimulus to Induce Early Ischemic Tolerance to Focal Cerebral Ischemia

Published on: May 9, 2013

Combined carotid endarterectomy and bypass for multi-level supra-aortic occlusive disease

Suraj Pai1, Suresh Pai2, Anirudh Sanjay Rao2

  • 1Department of Cardiovascular and Thoracic Surgery, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Karnataka, India drpaisuraj@gmail.com.

BMJ Case Reports
|July 31, 2026
PubMed

Insights

Surgical revascularization effectively treated a patient with complex carotid and subclavian artery occlusions causing upper limb ischemia and dizziness. The combined carotid endarterectomy and bypass restored limb perfusion and resolved symptoms.

Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Neurology

Background:

  • Subclavian artery occlusion causes upper limb ischemia and vertebrobasilar insufficiency.
  • Concurrent carotid artery occlusion complicates management, demanding complex surgical solutions.
  • Surgical revascularization is a viable option for select patients with these conditions.

Purpose of the Study:

  • To present a case of complex supra-aortic occlusive disease involving both subclavian and carotid arteries.
  • To highlight the successful surgical management of chronic ischemia in such a case.
  • To demonstrate the efficacy of a combined surgical approach.

Main Methods:

  • A female patient in her 60s with giddiness and left upper limb pain was evaluated.
  • Doppler ultrasound and CT angiography revealed left subclavian artery occlusion and left common/internal carotid artery occlusion.
  • The patient underwent left common carotid endarterectomy with carotid-to-subclavian bypass via a supraclavicular approach.

Main Results:

  • Post-operatively, pulses in the left upper limb were restored.
  • The patient experienced complete resolution of giddiness.
  • Follow-up Doppler imaging confirmed good arterial flow in the upper limb.

Conclusions:

  • Combined carotid endarterectomy and carotid-to-subclavian bypass is an effective treatment for complex supra-aortic occlusive disease.
  • This surgical strategy successfully restored limb perfusion and resolved ischemic symptoms.
  • Surgical revascularization offers a valuable therapeutic option for selected patients with combined carotid and subclavian artery occlusions.

Keywords:
Cardiovascular medicineSurgerySurgical Procedure, OperativeVascular surgery

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