Staged cerebral revascularization in a patient with an occluded common carotid artery.
OBJECTIVE
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.


CONCLUSIONS
Our experience with this case has led us to consider a staged approach for management of patients with an occluded common carotid artery.
Rabb
Craig H
CH
Department of Neurosurgery, University of Colorado School of Medicine, Denver, Colorado, USA. Craig.Rabb@dhha.org
Moneta
Gregory L
GL
D000792:Angiography; D001013:Aorta, Thoracic / Q000473:pathology; D001921:Brain / Q000473:pathology; D002340:Carotid Artery Diseases / Q000628:therapy*; D017536:Carotid Artery, Common / Q000473:pathology*; D002342:Carotid Artery, External / Q000473:pathology; D002548:Cerebral Revascularization; D001026:Coronary Artery Bypass; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke; D013348:Subclavian Artery / Q000473:pathology; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon