{"id":"1ecdae5a-d811-44d8-a040-6894953d6fd5","slug":"a-case-of-symptomatic-carotid-artery-occlusion-after-aortic-arch-replacement-treated-with-carotid-carotid-crossover-bypass","title":"A case of symptomatic carotid artery occlusion after aortic arch replacement treated with carotid-carotid crossover bypass","authors":["Yusuke Sakamoto","Kenko Maeda","Masaya Takemoto","Jungsu Choo","Mizuka Ikezawa","Ohju Fujita","Fumihiro Sago","Daiki Somiya","Akira Ikeda"],"abstract":"Background: Symptomatic common carotid artery (CCA) occlusion is rare and its treatment remains unestablished. Although cases of subclavian-to-carotid bypass have been reported, very few cases of carotid-tocarotid crossover bypass have been reported, despite its advantages. We report a case of Riles type 1A symptomatic CCA occlusion after aortic arch replacement that was treated with carotid-to-carotid crossover bypass with favorable outcomes. Case Description: A 65-year-old woman with a history of hypertension, hyperlipidemia, diabetes, and total arch replacement for thoracic aortic aneurysm was admitted to our hospital with a complaint of the right hemiparesis and motor aphasia. Head magnetic resonance imaging revealed a fresh infarction in the left cerebral hemisphere. Cervical computed tomography (CT) angiography revealed left CCA occlusion. Thoracic CT angiography showed severe stenosis of the left subclavian artery. SPECT showed a general decrease in blood flow in the left cerebral hemisphere. We performed a carotid-to-carotid crossover bypass with a synthetic graft that was passed through the subcutaneous tunnel. First, the right carotid artery-synthetic graft end-to-side anastomosis was performed. Subsequently, we performed synthetic graft-left CCA end-to-side anastomosis. The postoperative course was uneventful. Cervical computed tomography angiography showed perfect patency of the crossover bypass. The patient recovered almost completely and was independently performing daily activities. Conclusion: Carotid-to-carotid crossover bypass is a durable treatment for symptomatic CCA occlusion. Further studies are needed to compare its outcomes with those of other methods and to confirm our findings with larger sample size.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/1ecdae5a-d811-44d8-a040-6894953d6fd5/featured/hero-1781561226483.png","publishDate":"2022-06-23T00:00:00.000Z","doi":"10.25259/SNI_415_2022","categories":["Neurovascular","Case Report"],"fullTextUrl":"https://surgicalneurologyint.com/wp-content/uploads/2022/06/11680/SNI-13-273.pdf"}