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Updated: Aug 1, 2026
Bilateral Common Carotid Artery Occlusion as an Adequate Preconditioning Stimulus to Induce Early Ischemic Tolerance to Focal Cerebral Ischemia
Published on: May 9, 2013
Revascularization of cerebral ischemia after previous bilateral extracranial-intracranial bypass procedures
V S Sottiurai1, L Herbert, D Hatter
1Department of Surgery, Louisiana State University School of Medicine, New Orleans 70112-2822, USA.
Insights
Extracranial-intracranial (EC-IC) bypass surgery can effectively treat severe carotid artery disease. This case study shows successful management of external carotid and vertebral artery stenosis after EC-IC bypass, resolving patient ischemia.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Cerebrovascular Disease
Background:
- Extracranial-intracranial (EC-IC) bypass grafting was developed for bilateral internal carotid artery occlusion.
- Despite past effectiveness, EC-IC bypass has faced recent disfavor.
- Symptomatic stenosis in external carotid and vertebral arteries can occur post-EC-IC bypass.
Observation:
- A 68-year-old man presented with generalized cerebral ischemia, including confusion, ataxia, and daily syncope.
- Cerebral angiogram showed critical stenosis in bilateral external carotid arteries and the left vertebral artery.
- Transcranial Doppler indicated reduced cerebral and vertebral-basilar perfusion, though his EC-IC bypass graft remained patent since 1985.
Findings:
- The patient's symptoms of global ischemia and syncope resolved following carotid endarterectomy, external carotid artery bypass with vein patch, and vertebral-to-common carotid artery transposition.
- This case demonstrates successful surgical management of symptomatic external carotid and vertebral artery stenosis in a patient with a history of EC-IC bypass.
Implications:
- This report highlights the continued value of EC-IC bypass procedures in managing cerebrovascular disease.
- It underscores the importance of addressing secondary stenotic lesions in external carotid and vertebral arteries after EC-IC bypass to ensure adequate cerebral perfusion.
Abstract:
Extracranial-intracranial (EC-IC) bypass grafting procedures were specially designed for treatment of bilateral internal carotid artery occlusion. When performed in an expeditious manner, EC-IC bypass procedures have produced effective and durable results, despite the recent disfavor given to this procedure. This communication reports a 68-year-old white man who developed generalized cerebral ischemia manifested as confusion, incoherence, disorientation, ataxia, and numerous episodes of syncope daily. A cerebral angiogram revealed bilateral external carotid arteries and left solitary vertebral artery critical stenosis. Transcranial Doppler study demonstrated reduction of cerebral and vertebral-basilar perfusion. However, the patient's EC-IC bypass graft had remained patent since 1985. The patient's recurrent symptoms of global ischemia and syncope resolved after carotid endarterectomy, vein patch external carotid artery, and vertebral-to-common carotid artery transposition. This report reiterates the value of the EC-IC bypass procedure and presents the surgical management of symptomatic external carotid and vertebral artery stenosis in patients after EC-IC bypass procedures.
