Subclavian Artery-Carotid Artery Bypass for Subclavian Artery or Common Carotid Artery Severe Stenosis or Occlusion

Abstract

Various surgical treatments are available for occlusive subclavian and common carotid artery diseases. Nevertheless, to date, when cerebral endovascular treatment is utilized, revascularization via direct surgery may be required. This study reported five symptomatic cases of revascularization for CCA and SCA occlusive and stenotic lesions that were expected to be challenging to treat with endovascular treatment. We performed subclavian artery-common carotid artery or internal carotid artery bypass using artificial blood vessels or saphenous vein grafts in five patients with subclavian steal syndrome, symptomatic common carotid artery occlusion, and severe proximal common carotid artery stenosis. In this study, good bypass patency was achieved in all five cases. Although there were no intraoperative complications, one patient had a postoperative lymphatic leak. Moreover, there was no recurrence of stroke during postoperative follow-up for an average of 2 years. Conclusively, subclavian arterycommon carotid artery bypass can be an effective surgical treatment for common carotid artery occlusion, proximal common carotid artery stenosis, and subclavian artery occlusion.

Effects of percutaneous endovascular angioplasty for severe stenosis or occlusion of subclavian artery

“…The current therapeutic approaches for chronic obstructive lesions of the subclavian artery mainly consist of extra-anatomic carotid-subclavian bypass, percutaneous endovascular angioplasty and stent deployment 1 , 4 , 5 , 7 – 14 , 17 . Conservative medication may play a role in patients with subclavian artery stenosis, but endovascular angioplasty had a 60% risk of reduction for hemodynamic subclavian stenosis compared with conservative medication (adjusted hazard ratio 0.4, 95% confidence interval 0.2–0.6, P < 0.0001) even though a significant ( P = 0.3) symptomatic restenosis was detected at 42-month follow-up between patients treated with endovascular angioplasty and medication alone 18 .…”

Symptomatic Common Carotid Artery Stenosis Managed With Carotid Endarterectomy

“…In 2018, Wang et al [ 15 ] performed a retrospective review of 39 patients with long-segment, symptomatic, chronic CCA occlusive disease who underwent in-situ ring-stripper-mediated retrograde endarterectomy with a 100% technical success rate, with symptomatic improvement in all patients with no postoperative complications over 2.5 years. Other alternative treatments proposed for poor candidates for CAS include subclavian artery-CCA or ICA bypass, as demonstrated in a case series by Yamaguchi et al (2023) [ 16 ], with no symptom recurrence and good postoperative outcomes during a two-year follow-up. This option is supported by the largest literature review performed to date of CCAO management [ 4 ], which identifies 21 articles encompassing 146 patients with symptomatic disease.…”