Combined subclavian-external carotid and superficial temporal-middle cerebral artery bypass graft

Staged Cerebral Revascularization in a Patient With an Occluded Common Carotid Artery

Background and Purpose— We report a management strategy for cerebral revascularization in a patient with an occluded common carotid artery by first performing a subclavian to external carotid artery bypass, followed by superficial temporal artery middle cerebral artery (STA-MCA) bypass.

Methods— The patient presented with symptomatic left hemispheric hemodynamic insufficiency, associated with occlusion of the ipsilateral internal and common carotid arteries. The STA was not detectable. The patient was treated initially with a subclavian to external carotid artery bypass, with partial improvement in symptoms.

Results— Angiography demonstrated improvement in perfusion and STA filling, which was used for STA-MCA bypass, with resolution of symptoms.

Conclusion— Our experience with this case has led us to consider a staged approach for management of patients with an occluded common carotid artery.