Sakamoto Yusuke, Maeda Kenko, Takemoto Masaya, Choo Jungsu, Ikezawa Mizuka, Fujita Ohju, Sago Fumihiro, Somiya Daiki, Ikeda Akira
Department of Neurosurgery, Nagoya Ekisaikai Hospital.
Department of Neurosurgery, JCHO Chukyo Hospital, Nagoya, Japan.
Surg Neurol Int. 2022 Jun 23;13:273. doi: 10.25259/SNI_415_2022. eCollection 2022.
Symptomatic common carotid artery (CCA) occlusion is rare and its treatment remains unestablished. Although cases of subclavian-to-carotid bypass have been reported, very few cases of carotid-tocarotid crossover bypass have been reported, despite its advantages. We report a case of Riles type 1A symptomatic CCA occlusion after aortic arch replacement that was treated with carotid-to-carotid crossover bypass with favorable outcomes.
A 65-year-old woman with a history of hypertension, hyperlipidemia, diabetes, and total arch replacement for thoracic aortic aneurysm was admitted to our hospital with a complaint of the right hemiparesis and motor aphasia. Head magnetic resonance imaging revealed a fresh infarction in the left cerebral hemisphere. Cervical computed tomography (CT) angiography revealed left CCA occlusion. Thoracic CT angiography showed severe stenosis of the left subclavian artery. SPECT showed a general decrease in blood flow in the left cerebral hemisphere. We performed a carotid-to-carotid crossover bypass with a synthetic graft that was passed through the subcutaneous tunnel. First, the right carotid artery-synthetic graft end-to-side anastomosis was performed. Subsequently, we performed synthetic graft-left CCA end-to-side anastomosis. The postoperative course was uneventful. Cervical computed tomography angiography showed perfect patency of the crossover bypass. The patient recovered almost completely and was independently performing daily activities.
Carotid-to-carotid crossover bypass is a durable treatment for symptomatic CCA occlusion. Further studies are needed to compare its outcomes with those of other methods and to confirm our findings with larger sample size.
有症状的颈总动脉（CCA）闭塞很少见，其治疗方法尚未确立。尽管已报道了锁骨下动脉至颈动脉搭桥的病例，但尽管颈动脉至颈动脉交叉搭桥有其优势，报道的病例却非常少。我们报告一例主动脉弓置换术后出现Riles 1A型有症状CCA闭塞的病例，该病例采用颈动脉至颈动脉交叉搭桥治疗，效果良好。
一名65岁女性，有高血压、高脂血症、糖尿病病史，因胸主动脉瘤接受全弓置换，因右侧偏瘫和运动性失语入住我院。头部磁共振成像显示左侧大脑半球有新鲜梗死灶。颈部计算机断层扫描（CT）血管造影显示左侧CCA闭塞。胸部CT血管造影显示左侧锁骨下动脉严重狭窄。单光子发射计算机断层扫描（SPECT）显示左侧大脑半球血流普遍减少。我们使用合成移植物通过皮下隧道进行了颈动脉至颈动脉交叉搭桥。首先，进行右侧颈动脉-合成移植物端侧吻合。随后，进行合成移植物-左侧CCA端侧吻合。术后过程顺利。颈部CT血管造影显示交叉搭桥完全通畅。患者几乎完全康复，能够独立进行日常活动。
颈动脉至颈动脉交叉搭桥是治疗有症状CCA闭塞的一种持久方法。需要进一步研究以将其结果与其他方法的结果进行比较，并以更大样本量证实我们的发现。
