{"id":"0c37b28f-013c-4542-9e6f-b983a05f9086","slug":"less-invasive-bonnet-bypass-with-subcutaneous-tunneling-method-for-common-carotid-artery-occlusion-a-technical-note","title":"Less invasive bonnet bypass with subcutaneous tunneling method for common carotid artery occlusion – A technical note","authors":["Yusuke Sakamoto","Sho Okamoto","Ryuta Saito"],"abstract":"Background: Common carotid artery occlusion (CCAO) sometimes requires vascular reconstruction. Ipsilateral superficial temporal artery (STA)-middle cerebral artery (MCA) bypass is unsuitable due to insufficient blood flow to the external carotid artery. The bonnet bypass, one treatment option for CCAO, requires a long coronal incision and bone groove to prevent malposition and collapse of an interposition graft. However, this long incision might lead to skin complications and reduced collateral blood flow. Methods: A 60-year-old man who experienced recurrent ischemic stroke presented with the right internal carotid artery occlusion and left CCAO. The left STA was unavailable; however, both branches of his right STA were well-developed. Minimizing skin invasion was a priority because the patient had diabetes mellitus. We performed a right STA parietal branch – right MCA anastomosis, followed by a right STA frontal branch – left radial artery graft (RAG) – left MCA bonnet bypass using small intermittent skin incisions. Results: We drilled a bone groove extending across the entire length of the interposition graft through the small intermittent skin incisions. Furthermore, we applied a right STA-RAG end-to-side anastomosis instead of an endto-end anastomosis to preserve collateral skin anastomosis. Postoperatively, the bypass remained patent, and the patient was discharged without complications. Conclusion: The bonnet bypass is a potential treatment for CCAO, but the procedure is invasive. Our modified bonnet bypass method enables less invasive management, preventing collapse and malposition of the interposition graft and minimizing skin complications.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/0c37b28f-013c-4542-9e6f-b983a05f9086/featured/hero-1781559306248.png","publishDate":"2024-08-23T00:00:00.000Z","doi":"10.25259/SNI_528_2024","categories":["Neurovascular","Technical Note"],"fullTextUrl":"https://surgicalneurologyint.com/api/articles/0c37b28f-013c-4542-9e6f-b983a05f9086/pdf"}