Subclavian-Carotid Bypass as a Solution to Recurrent Carotid Artery Stenosis Post Endarterectomy and Transfemoral Stenting

TL;DR

An 80-year-old man with recurring carotid artery blockages underwent a subclavian-carotid bypass surgery, which successfully restored blood flow.

Contribution

This case highlights the use of subclavian-to-distal carotid bypass as a novel solution for recurrent stenosis when traditional methods fail.

Findings

The patient's postoperative recovery was successful with a patent graft confirmed by ultrasound.

A subclavian-carotid bypass was found feasible when transfemoral stenting and common carotid bypass were not options.

The case emphasizes the importance of alternative surgical approaches in managing recurrent carotid stenosis.

Abstract

We present the case of an 80-year-old man who underwent a subclavian-to-distal internal carotid artery bypass with a reversed saphenous vein due to symptomatic in-stent restenosis, following a carotid endarterectomy 20 years ago and carotid artery stenting 10 years ago.

The patient presented with right-sided hemiparesis and dysarthria. Imaging suggested in-stent restenosis of the internal carotid artery stent. He was also found to have stenosis of the common carotid artery origin stent. An initial transfemoral attempt by interventional radiology was unsuccessful. Due to the stenosed common carotid artery origin stent, a common carotid-to-internal carotid artery bypass was not feasible. Therefore, a subclavian-distal carotid artery bypass with a reversed saphenous vein was performed.

He did well in the postoperative period and has been seen in the clinic since. Surveillance ultrasound demonstrated a patent graft with non-stenotic proximal and distal anastomoses. We include an in-depth review of the management of recurrent carotid artery stenosis as well.

Figures