This case report highlights a surgical technique using a temporary intraluminal shunt to safely perform simultaneous reconstruction of carotid and vertebral arteries in a patient intolerant to temporary occlusion.
Feasibility shown in one case should not change practice for combined carotid-vertebral lesions; leaves open need for prospective validation of shunt technique.
The article describes a case of one-stage surgical treatment of a patient with progressive chronic cerebral ischemia caused by combined steno-occlusive lesions of the carotid and vertebral arteries. The disease was complicated by intolerance to temporary occlusion of the carotid artery due to an incomplete circle of Willis. We performed extra-anatomic carotid-vertebral artery bypass with subsequent ipsilateral carotid endarterectomy. A temporary intraluminal shunt was used at the main stage of reconstructive surgery. We use this clinical case to analyze the issues of surgical treatment for combined lesions of the carotid and vertebral arteries and the techniques for prevention of associated ischemic complications.
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Usachev et al. (2017) studied this question.
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