Revascularisation for symptomatic common carotid artery occlusion: neurosurgical practice and outcomes of subclavian artery-common carotid artery bypass grafting
Retrospective study demonstrates favorable patency and perfusion recovery after subclavian-to-carotid bypass in common carotid occlusion, highlighting a viable revascularization alternative.
Key Points
To evaluate the clinical efficacy, technical nuances, and safety of subclavian artery-to-common carotid artery bypass grafting for patients with symptomatic complete common carotid artery occlusion.
Retrospective single-cohort study of 20 symptomatic patients with complete common carotid artery occlusion and ipsilateral hypoperfusion documented on CT perfusion.
Preoperative workup included CT angiography, CT perfusion, and high-resolution MRI; surgical indications were recurrent ischemic events and significant ipsilateral hypoperfusion.
Patients underwent bypass grafting using prosthetic grafts with intraoperative indocyanine green angiography, followed by standardized anticoagulation, antiplatelet, and statin regimens.
The primary graft patency rate was 85% (17/20), and after successful emergency thrombectomy in one occluded case, final secondary patency reached 90% (18/20).
Perfusion analysis demonstrated a statistically significant reduction in the time to maximum >6 s hypoperfusion volume (p=0.004) in patients with patent grafts.
Postoperative complications comprised asymptomatic acute ischemic stroke (2/20), pleural effusion (1/20), and extended intensive care stay (1/20), with a median follow-up modified Rankin Scale score of 0.