Subclavian Artery-Internal Carotid Artery Bypass Using a Radial Artery Graft for Common Carotid Artery Occlusion with Immediate Improvement of Cognitive Function: A Case Report.

Introduction: Although rare, common carotid artery occlusion (CCAO) causes ischemic neurological dysfunction, which can be treated by revascularization. Although several bypass approaches for CCAO have been suggested, no consensus on the surgical revascularization approach and its functional outcome have been reached. Herein, we present a case of Rile's type 1A CCAO in which a subclavian artery (SclA)-internal carotid artery (ICA) bypass using a radial artery graft (RAG) resulted in immediate recovery of cognitive function and successfully prevented ischemic stroke.

Case description: A 58-year-old man presented with recurrent episodes of right-sided weakness. Brain magnetic resonance imaging revealed multiple cerebral infarcts. Digital subtraction angiography confirmed left CCAO and no anterograde blood flow in the left ICA and ipsilateral external carotid artery. A bypass was performed from the left SclA to the left cervical ICA using a left RAG, and supraclavicular anastomosis between the SclA and ICA was performed without graft-vessel kinking. Postoperatively, no neurological deficits were observed, and his cognitive function was successfully improved.

Conclusion: SclA-ICA bypass using an RAG can be a reasonable treatment option for CCAO. CCAO revascularization can prevent ischemic stroke and improve cognitive function.