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Bypass strategies for common carotid artery occlusion

  • Original Article - Vascular Neurosurgery - Ischemia
  • Published:
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Abstract

Background

Common carotid artery occlusion (CCA-occlusion) is a rare condition where standard revascularization is not feasible. Here, we analyzed our experience with surgical revascularization of CCA-occlusion to develop an algorithm for selection of the most suitable bypass strategy according to the Riles classification.

Methods

During a 10-year period, 16 out of 288 patients with cerebrovascular disease and compromised hemodynamic reserve underwent revascularization for unilateral CCA-occlusion. The utilized bypass strategies included (1) a saphenous vein graft from the subclavian artery (SA) to the internal carotid artery (ICA), (2) a radial artery graft from the V3 segment of the vertebral artery (VA) to a superficial branch of the middle cerebral artery (MCA), or (3) a saphenous vein graft from the SA to a deep branch of the MCA.

Results

In CCA-occlusion with maintained external carotid artery (ECA)/ICA patency (Riles type 1A), an SA-ICA bypass was performed (25%). In cases without ECA/ICA patency (Riles type 1B or 2) but suitable VA, a VA-MCA bypass was grafted (31%). In cases with unsuitable VA, a long SA-MCA interposition bypass was performed (38%). Transient postoperative neurological deficits occurred in 5 patients (31%) with 1 patient (6%) suffering permanent neurological worsening and 1 mortality (6%). Overall, no difference was found between the median preoperative mRS (2; range, 1–4) and the mRS at the time point of the last follow-up (2; range, 1–6; p = 0.75). The long-term graft patency was 94%.

Conclusions

Although surgical revascularization for CCA-occlusion is feasible, it is associated with a higher risk than standard bypass grafting. Considering the poor natural history of CCA-occlusion, however, this risk may be justified in carefully selected patients.

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Authors and Affiliations

  1. Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany

    Nils Hecht, Lars Wessels, Lucius Fekonja & Peter Vajkoczy

  2. Department of Neurology, Aarhus University Hospital, Aarhus, Denmark

    Paul von Weitzel-Mudersbach

  3. Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Peter Vajkoczy

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  1. Nils Hecht
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  2. Lars Wessels
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  3. Lucius Fekonja
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  4. Paul von Weitzel-Mudersbach
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  5. Peter Vajkoczy
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Correspondence to Peter Vajkoczy.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (ethics committee of the Charité University Hospital in Berlin, Germany; EA2/178/18) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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This article is part of the Topical Collection on Vascular Neurosurgery - Ischemia

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Hecht, N., Wessels, L., Fekonja, L. et al. Bypass strategies for common carotid artery occlusion. Acta Neurochir 161, 1993–2002 (2019). https://doi.org/10.1007/s00701-019-04001-4

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  • DOI: https://doi.org/10.1007/s00701-019-04001-4

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