Staged cerebral revascularization in a patient with an occluded common carotid artery.

BACKGROUND AND PURPOSE We report a management strategy for cerebral revascularization in a patient with an occluded common carotid artery by first performing a subclavian to external carotid artery bypass, followed by superficial temporal artery middle cerebral artery (STA-MCA) bypass. METHODS The patient presented with symptomatic left hemispheric hemodynamic insufficiency, associated with occlusion of the ipsilateral internal and common carotid arteries. The STA was not detectable. The patient was treated initially with a subclavian to external carotid artery bypass, with partial improvement in symptoms. RESULTS Angiography demonstrated improvement in perfusion and STA filling, which was used for STA-MCA bypass, with resolution of symptoms. CONCLUSIONS Our experience with this case has led us to consider a staged approach for management of patients with an occluded common carotid artery.