Thyrocervical trunk-external carotid artery bypass for positional cerebral ischemia due to common carotid artery occlusion. Report of three cases.
Medically refractory positional cerebral ischemia and concomitant orthostatic hypotension associated with chronic common carotid artery (CCA) occlusion are rare. The authors detail their experience with three cases treated exclusively by an extracranial bypass in which the thyrocervical trunk was used as the donor vessel. Postoperatively grafts were patent and symptoms resolved in all three patients, although orthostatic hypotension remained. Postural cerebral ischemia due to CCA occlusion can be treated by extracranial bypass surgery. The thyrocervical trunk is a suitable donor for reconstruction of the external carotid artery in these cases.
Melgar
Miguel A
MA
Division of Neurosurgery, University of Arizona College of Medicine, Tucson, USA. melgar@u.arizona.edu
Weinand
Martin E
ME
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001157:Arterial Occlusive Diseases / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D002340:Carotid Artery Diseases / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D017536:Carotid Artery, Common / Q000473:pathology*; D002342:Carotid Artery, External / Q000601:surgery*; D002533:Cerebral Angiography; D002548:Cerebral Revascularization / Q000379:methods*; D004244:Dizziness / Q000209:etiology; D004809:Ephedrine / Q000008:administration & dosage / Q000627:therapeutic use; D005438:Fludrocortisone / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D007024:Hypotension, Orthostatic / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D002546:Ischemic Attack, Transient / Q000209:etiology / Q000601:surgery*; D008875:Middle Aged; D010291:Paresis / Q000209:etiology; D011187:Posture; D015899:Tomography, Emission-Computed, Single-Photon; D014786:Vision Disorders / Q000209:etiology; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D014859:Warfarin; D004809:Ephedrine; D005438:Fludrocortisone; C034635:fludrocortisone acetate