An alternative approach to lesions in the proximal segments of the brachiocephalic arterial system.

Tolerance of a cerebral hemisphere to permanent interruption of the ipsilateral carotid artery or to prolonged operative clamping of this vessel, can be determined preoperatively by a noninvasive technique combining the use of the ocular pneumoplethysmograph with compression of the proximal part of the common carotid artery. This technique is essential for the management of proximal lesions of the brachiocephalic arterial system to avoid the use of bypass grafts and to permit a supraclavicular approach rather than thoracotomy or a median plane sternotomy.