We have reviewed four cases of incomplete vascular rings caused by the presence of a common carotid trunk from which arose both carotid arteries associated with an aberrant right subclavian artery. The patients were aged between 3 and 9 months. All patients presented with recurrent respiratory tract infections. Three patients showed signs of malnutrition and failure to thrive caused by episodes of bronchial aspiration from extrinsic compression of the oesophagus. One patient presented with dyspnoea induced by feeding and another had stridor. A common carotid trunk associated with an aberrant subclavian artery was confirmed in all cases. No other associated anomaly was observed in any patient. Ligature and section of the anomalous right subclavian artery was performed in all patients. The low incidence of this type of vascular ring, its physiopathological mechanism and surgical management are discussed.

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This middle-aged patient had undergone surgical placement of a left subclavian to internal carotid artery bypass graft five years ago for treatment of symptomatic, chronic, bilateral carotid occlusions. The patient was neurologically intact after the procedure and until the day of presentation with symptoms of an acute left anterior circulation stroke. Initial workup confirmed acute occlusion of the graft as the cause of the patient's symptoms. Endovascular recanalization of the bypass graft in the setting of chronic bilateral carotid occlusions was a technical and conceptual challenge. Simultaneous radial and femoral vascular access allowed for direct recanalization of the graft (through thrombectomy, angioplasty, and stent placement) with intraoperative patency surveillance of the circle of Willis via the posterior circulation. Most of the neurological deficits improved, and the patient was discharged to rehabilitation close to neurologic baseline.

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