Subclavian Artery to Internal Carotid Artery Interpositional Bypass for Carotid Artery Occlusion: Technical Case Report

2020 ◽  
Vol 20 (1) ◽  
pp. E66-E71
Author(s):  
Joshua S Catapano ◽  
Fabio A Frisoli ◽  
Gabriella M Paisan ◽  
Katherine A Dunn ◽  
Ankush Bajaj ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Radial Artery ◽  
Subclavian Artery ◽  
Common Carotid Artery ◽  
Internal Carotid ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Radial Artery Graft ◽  
Artery Graft

Abstract BACKGROUND AND IMPORTANCE Conventional microsurgical treatment for symptomatic internal carotid artery (ICA) occlusion is revascularization with superficial temporal artery (STA) to middle cerebral artery bypass. However, in rare cases where the common carotid artery, external carotid artery (ECA), or both are also occluded, other microsurgical treatment options must be considered. CLINICAL PRESENTATION We present the case of a 52-yr-old woman with common carotid artery occlusion and weak ICA flow from collateral connections between the vertebral artery, occipital artery, and ECA. She had ischemic symptoms and a history of stroke. The patient's STA was unsuitable as a donor vessel due to its small caliber and poor flow, and we instead performed an interpositional bypass from the subclavian artery to the ICA using a radial artery graft. CONCLUSION This case illustrates the successful use of the subclavian artery to ICA bypass technique with an interpositional radial artery graft. The surgical anatomy of the subclavian arteries is reviewed, and the technical details of subclavian artery to radial artery graft to ICA interpositional bypass are presented.

scholarly journals High flow bypass for right giant cavernous internal carotid artery aneurysm with fibromuscular dysplasia of cervical internal carotid artery: microsurgical 2-D video

2020 ◽  
Vol 11 ◽  
pp. 177
Author(s):  
Miguel Angel Lopez-Gonzalez ◽  
Xiaochun Zhao ◽  
Dinesh Ramanathan ◽  
Timothy Marc Eastin ◽  
Song Minwoo
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Radial Artery ◽  
Fibromuscular Dysplasia ◽  
Internal Carotid ◽  
High Flow ◽  
Oculomotor Nerve Palsy ◽  
Radial Artery Graft ◽  
Artery Graft ◽  
Cervical Internal Carotid Artery

Background: It is well known that intracranial aneurysms can be associated to fibromuscular dysplasia (FMD). Nevertheless, it is not clear the best treatment strategy when there is an association of giant symptomatic cavernous carotid aneurysm with extensive cervical internal carotid artery (ICA) FMD. Case Description: We present the case of 63 year-old right-handed female with hypothyroidism, 1 month history of right-sided pulsatile headache and visual disturbances with feeling of fullness sensation and blurry vision. Her neurological exam showed partial right oculomotor nerve palsy with mild ptosis, asymmetric pupils (right 5 mm and left 3mm, both reactive), and mild exotropia, normal visual acuity. Computed tomography angiogram and conventional angiogram showed 2.5 × 2.6 × 2.6 cm non-ruptured aneurysm arising from cavernous segment of the right ICA. She had right hypoplastic posterior communicant artery, and collateral flow through anterior communicant artery during balloon test occlusion and the presence of right cervical ICA FMD. The patient was started on aspirin. After lengthy discussion of treatment options in our neurovascular department, between observations, endovascular treatment with flow diverter device, or high flow bypass, recommendation was to perform high flow bypass and patient consented for the procedure. We performed right-sided pterional trans-sylvian microsurgical approach and right neck dissection at common carotid bifurcation under electrophysiology monitoring (somatosensory evoked potentials and electroencephalography); while vascular surgery department assisted with the radial artery graft harvesting. The radial artery graft was passed through preauricular tunnel, cranially was anastomosed at superior trunk of middle cerebral artery, and caudally at external carotid artery (Video). Intraoperative angiogram showed adequate bypass patency and lack of flow within aneurysm. The patient was extubated postoperatively and discharged home with aspirin in postoperative day 5. Improvement on oculomotor deficit was complete 3 weeks after surgery. Conclusion: Nowadays, endovascular therapy can manage small to large cavernous ICA aneurysms even if associated to FMD, although giant symptomatic cavernous carotid aneurysms impose a different challenge. Here, we present the management for the association of symptomatic giant cavernous ICA aneurysm and cervical ICA FMD with high flow bypass. We consider important to keep the skills in the cerebrovascular neurosurgeon armamentarium for the safe management of these lesions.

scholarly journals Posttraumatic Carotid-Cavernous Fistulae Treated by Internal Carotid Artery Trapping and High-Flow Bypass Using a Radial Artery Graft

2011 ◽  
Vol 51 (2) ◽  
pp. 113-116 ◽  
Author(s):  
Takayuki MIZUNARI ◽  
Yasuo MURAI ◽  
Kyongsong KIM ◽  
Shiro KOBAYASHI ◽  
Hiroyasu KAMIYAMA ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Radial Artery ◽  
Internal Carotid ◽  
High Flow ◽  
Radial Artery Graft ◽  
Artery Graft

Long-term patency of radial artery graft bypass for reconstruction of the internal carotid artery

1999 ◽  
Vol 90 (4) ◽  
pp. 786-790 ◽  
Author(s):  
Kiyohiro Houkin ◽  
Hiroyasu Kamiyama ◽  
Satoshi Kuroda ◽  
Tatsuya Ishikawa ◽  
Akihiro Takahashi ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Radial Artery ◽  
Internal Carotid ◽  
Radial Artery Graft ◽  
Conventional Angiography ◽  
Content Type ◽  
Artery Graft ◽  
Fine Print

✓ Reconstruction of the carotid artery by using a radial artery graft is a useful option that can produce reliable long-term patency for the surgical treatment of giant and/or large aneurysms of the cavernous and paraclinoid internal carotid artery (ICA).During the past 10 years, 43 patients with intracavernous and paraclinoid giant aneurysms of the ICA have been treated by reconstruction of the ICA with radial artery grafts after ligation of the cervical ICA. The long-term patency of the grafted radial artery was evaluated over more than a 5-year period (mean 7.2 years) in 20 of these patients by using magnetic resonance angiography or conventional angiography. There was no late occlusion of the graft in any of these cases. Stenotic graft changes were observed in two cases.

Internal Carotid Artery Patency following Common Carotid Artery Occlusion: Management of the Asymptomatic Patient

1999 ◽  
Vol 13 (1) ◽  
pp. 73-76 ◽  
Author(s):  
David L. Cull ◽  
John C. Hansen ◽  
Spence M. Taylor ◽  
Eugene M. Langan ◽  
Bruce A. Snyder ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Common Carotid Artery ◽  
Internal Carotid ◽  
Asymptomatic Patient ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Common Carotid Artery Occlusion
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