Treatment of hemodynamic insufficiency in chronic CCA occlusion using a short saphenous vein interposition graft: diagnostic and technical considerations. An illustrative case report.
Extracranial-intracranial bypass surgery has been shown to reverse hemodynamic insufficiency on the basis of steno-occlusive disease of the internal carotid artery (ICA) or middle cerebral artery. In contrast, chronic occlusion of the common carotid artery (CCA) without extracranial donor vessels affords alternative revascularization procedures as well as a more elaborate preoperative workup. This case is intended to illustrate the specific diagnostic approach and considerations as well as a beneficial treatment modality in the setting of pronounced hemodynamic insufficiency as a consequence of a CCA occlusion, in conjunction with contralateral CCA and ICA stenoses. A 61-year-old man complaining of new onset aphasia underwent vascular imaging that revealed a proximal occlusion of the left CCA with a concomitant patent proximal ICA on ultrasound. Functional cerebral blood flow measurement including Xenon-enhanced computer tomography showed corresponding chronic hemodynamic insufficiency of the left hemisphere. The patient received a modified revascularization procedure, where a saphenous vein was used as interposition graft between the subclavian artery and the left proximal ICA. Postoperatively, both clinical and morphological improvement were noted. Successful treatment of hemodynamic insufficiency because of chronic CCA occlusion necessitates a thorough preoperative workup and application of alternative revascularization strategies.
Schubert
Gerrit Alexander
GA
Department of Neurosurgery, University Hospital Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany. gerrit.schubert@nch.ma.uni-heidelberg.de
Rewerk
Stephan
S
Riester
Thomas
T
Huck
Kurt
K
Vajkoczy
Peter
P
D017536:Carotid Artery, Common / Q000601:surgery*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D002548:Cerebral Revascularization / Q000379:methods; D002560:Cerebrovascular Circulation; D003287:Contrast Media; D006801:Humans; D008297:Male; D008875:Middle Aged; D012501:Saphenous Vein / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D014978:Xenon
D003287:Contrast Media; D014978:Xenon