Common carotid artery occlusion with patent internal and external carotid arteries: Diagnosis and surgical management

1993 ◽  
Vol 17 (6) ◽  
pp. 1019-1028 ◽  
Author(s):  
Lawrence I. Deckelbaum ◽  
Michael I. Belkin ◽  
William C. Mackey ◽  
Michael S. Pessin ◽  
Louis R. Caplan
Keyword(s):  
Carotid Artery ◽  
Surgical Management ◽  
Common Carotid Artery ◽  
Carotid Arteries ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
External Carotid ◽  
Common Carotid Artery Occlusion

scholarly journals Side-to-side reverse superficial temporal artery to M4 middle cerebral artery bypass for common carotid artery occlusion with bonnet collaterals: illustrative case

2021 ◽  
Vol 1 (19) ◽  
Author(s):  
Lekhaj C. Daggubati ◽  
Varun Padmanaban ◽  
Ephraim W. Church
Keyword(s):  
Carotid Artery ◽  
Common Carotid Artery ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Fourth Generation ◽  
External Carotid ◽  
Retrograde Flow ◽  
Common Carotid Artery Occlusion

BACKGROUND The bonnet bypass was initially described for common carotid artery occlusion. Considered a second-generation bypass, it augments intracranial perfusion with contralateral external carotid artery flow through an interposition graft running over the scalp vertex. However, the traditional first-generation low-flow superficial temporal artery (STA)-M4 middle cerebral artery (MCA) bypass may be enhanced by performing a side-to-side (S-S) bypass with an intraluminal suture technique (fourth-generation bypass) to increase perfusion through antegrade and retrograde flow. OBSERVATIONS The authors present a reimagined S-S STA-M4 bypass in the case of a patient with symptomatic common carotid occlusion, in which the ipsilateral STA filled in a reverse fashion from the contralateral external carotid branches over the scalp vertex (bonnet collaterals). By performing an S-S anastomosis, the authors were able to improve cerebral perfusion and avoid the multiple anastomosis sites of the bonnet bypass. LESSONS The patient had a good recovery with resolution of his preoperative symptoms. Follow-up angiography showed a patent bypass supplying the MCA territory through retrograde flow in the frontal and parietal limbs of the STA, converging at the anastomosis site. In this report, the authors present a new fourth-generation bypass dubbed the “S-S reverse STA-M4 MCA bypass.”

scholarly journals Endovascular Treatment of Aneurysmal Subarachnoid Hemorrhage Associated with Bilateral Common Carotid Artery Occlusion

2008 ◽  
Vol 14 (4) ◽  
pp. 447-452 ◽  
Author(s):  
T. Meguro ◽  
T. Tanabe ◽  
K. Muraoka ◽  
K. Terada ◽  
N. Hirotsune ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Common Carotid Artery ◽  
Carotid Arteries ◽  
Posterior Cerebral Artery ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Double Balloon ◽  
Bilateral Common Carotid Artery ◽  
Common Carotid Artery Occlusion ◽  
Common Carotid Arteries

Cases of aneurysm associated with the occlusion of both common carotid arteries are very rare. We present a case of ruptured aneurysms of the basilar bifurcation and posterior cerebral artery coexisting with bilateral common carotid artery occlusion, successfully treated by endovascular coil embolization with a double-balloon remodeling technique. Finally, we review the literature. A 62-year-old woman presented with severe headache; a computed tomography scan demonstrated subarachnoid hemorrhage. Angiography revealed that the bilateral common carotid arteries were occluded. The muscle branches of the vertebral arteries had anastomosed to the bilateral external carotid arteries. Bilateral posterior communicating arteries had developed and supplied the bilateral internal carotid arteries. Two aneurysms (a saccular aneurysm of the P1 portion of the left posterior cerebral artery and a wide-necked aneurysm of the basilar bifurcation) were also observed. Endovascular embolization of the aneurysms was successfully performed using a double-balloon remodeling technique. The patient made a full recovery after treatment, and the aneurysms remained obliterated 12 months after embolization. We believe that this is the first report of ruptured aneurysms associated with bilateral common carotid artery occlusion successfully treated by endovascular coiling. The double-balloon remodeling technique was useful for treatment of wide-necked basilar bifurcation aneurysm.

Surgical Treatment of Common Carotid Artery Occlusion

Neurosurgery ◽  
1983 ◽  
Vol 12 (5) ◽  
pp. 515-524 ◽  
Author(s):  
Massimo Collice ◽  
Vincenzo D'Angelo ◽  
Orazio Arena
Keyword(s):  
Surgical Treatment ◽  
Carotid Artery ◽  
Common Carotid Artery ◽  
Carotid Bifurcation ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
External Carotid Artery ◽  
External Carotid ◽  
Proximal Lesion ◽  
Common Carotid Artery Occlusion

Abstract Complete occlusion of the common carotid artery (CCA) has been found in 4 to 5% of patients suffering from cerebral ischemia due to atherosclerotic lesions. The classical surgical treatment of the lesion consists of retrograde thromboendar-terectomy or bypass grafting between the subclavian artery and the carotid bifurcation with the aim of restoring flow into the internal carotid artery (ICA) or revascularizing the external carotid artery (ECA) when the ICA is definitively occluded. Recent reconstructive microneurosurgical techniques offer these patients alternative or additional possibilities of cerebral revascularization. During the last 5 years, we have treated nine patients with CCA occlusion, using different techniques mainly according to the site and extent of obstruction and the anatomical conditions of the arteries. In only one patient was the ICA found to be patent: a subclavian-ICA bypass was performed. In four other patients with occlusion of the full length of the CCA (proximal lesion) and ICA occlusion, attempts at retrograde thromboendarterectomy were made and then subclavian-ECA bypass and superficial temporal-middle cerebral artery (STA-MCA) bypass were performed in two steps. In four patients with CCA obstruction limited to the carotid bifurcation area (distal lesion) and with ICA occlusion, the following techniques were used: (a) endarterectomy of the CCA and ECA and STA-MCA bypass in two steps (one case), (b) CCA-ECA bypass and STA-MCA bypass in two steps (one case), and (c) subclavian-MCA bypass (two cases). Four of nine patients were treated by contralateral ICA endarterectomy after repair of the CCA obstruction. Angiography was performed 7 to 10 days after every surgical procedure, and all arteries and grafts, originally opened, were found to be patent. No operative death occurred in the series, but one patient suffered a transient neurological deficit. During the follow-up period (average, 14 months), no ischemic episode occurred. These data suggest that a versatile surgical approach is rational for the treatment of CCA occlusion.

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