Open surgical treatment of a patient with multiple lesions of supra-aortic arteries

This article describes cerebral revascularization in a patient with symptomatic stenoses (transient ischemic attack in March 2023) of brachiocephalic arteries (NASCET): internal carotid artery (ICA) on the left 90%, ICA on the right 99%, common carotid artery (CCA) on the left 80%, the first segment of the left subclavian artery 90%. Doppler ultrasound revealed complete steal syndrome on the left. At the first stage, the patient underwent classic carotid endarterectomy (CEE) on the right with autologous patch repair under temporary shunting. After 2 weeks, the second surgery was performed: eversion CEE from the left CCA+classical CEE from the left ICA with synthetic patch repair+carotid-subclavian bypass with synthetic prosthesis. In postoperative period, there was a violation of swallowing and difficult breathing due to local edema and inflammation on the left. Symptoms regressed under therapy. The patient was discharged in 14 days after surgery.