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(Stroke. 2005;36:e68.)
© 2005 American Heart Association, Inc.

Case Reports

Staged Cerebral Revascularization in a Patient With an Occluded Common Carotid Artery

From the Department of Neurosurgery (C.H.R.), University of Colorado School of Medicine, Denver, Colo; and the Division of Vascular Surgery (G.L.M.), Oregon Health Sciences University, Portland, Ore.

Correspondence to Craig H. Rabb, MD, 777 Bannock, MC-0206, Denver, CO 80204-4507. E-mail Craig.Rabb{at}dhha.org

Abstract

Background and Purpose— 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.

Conclusion— Our experience with this case has led us to consider a staged approach for management of patients with an occluded common carotid artery.

Key Words: bypass surgery • carotid artery occlusion • cerebral ischemia