{
  "abstract": "Background: Total occlusion of the common carotid artery (CCA) from its origin is rare, occurring in less than 1% of brachiocephalic stenoses. Surgical revascularization is technically demanding, especially with tandem severe ipsilateral internal carotid artery (ICA) stenosis. Procedures under regional anesthesia with continuous neurologic monitoring are rarely described.\n\nObjective: To evaluate outcomes of subclavian-to-internal carotid artery bypass with carotid endarterectomy (CEA) in symptomatic patients with total CCA occlusion and severe ipsilateral ICA stenosis under regional anesthesia with awake neurologic monitoring.\n\nMethods: This retrospective single-center case series included 4 symptomatic male patients (mean age 68.0 years, range 59–75) with total CCA occlusion (Riles type 1A) and severe ipsilateral ICA stenosis (80%–95% by NASCET), who underwent subclavian-to-internal carotid bypass with ICA endarterectomy under cervical plexus and supraclavicular brachial plexus block with 0.5% ropivacaine between December 2021 and June 2026. Neurologic status was monitored continuously in awake patients during carotid cross-clamping. Systolic blood pressure was maintained approximately 20 mmHg above preoperative baseline to optimize collateral perfusion.\n\nResults: Primary technical success was 100%. Mean carotid cross-clamping time was 19.3 min (range, 17–21 min). Retrograde ICA stump pressure was ≥40 mmHg in all patients. No intraoperative neurologic deficits, perioperative strokes, transient ischemic attacks, cranial nerve injuries, graft thromboses, or deaths occurred. At the latest available follow-up, all grafts remained patent and no recurrent neurologic events were recorded. Twelve-month follow-up was available for Patients A, C, and D, whereas Patient B had 3 months of follow-up. One patient with contralateral 98% ICA stenosis underwent staged contralateral CEA one month later.\n\nConclusion: In this small case series, subclavian-to-internal carotid artery bypass combined with ICA endarterectomy under regional anesthesia with awake neurologic monitoring was technically feasible and was associated with favorable observed perioperative and available follow-up outcomes. Larger comparative studies are warranted.",
  "abstract_shown": true,
  "affiliations": [
    "Professor G. V. Tsoi Scientific and Educational Center of Surgery, NJSC “Astana Medical University” , ,",
    "Scientific Research Institute of Radiobiology and Radiation Protection, NJSC “Astana Medical University” , ,",
    "Department of Interventional Radiology, CF University Medical Center , ,",
    "Clinical Academic Department of Anesthesiology and Intensive Care, CF University Medical Center , ,",
    "Center for Vascular and Reconstructive Surgery, National Research Oncology Center , ,"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Yerbol Dogalbayev"
    },
    {
      "affs": [
        1
      ],
      "name": "Kuralay Ilbekova"
    },
    {
      "affs": [
        2
      ],
      "name": "Ruslan Tukinov"
    },
    {
      "affs": [
        3
      ],
      "name": "Gulnar Mustafinova"
    },
    {
      "affs": [
        3
      ],
      "name": "Nurlan Azimzhanov"
    },
    {
      "affs": [
        3
      ],
      "name": "Seilbek Beketov"
    },
    {
      "affs": [
        3
      ],
      "name": "Didar Kadyrbek"
    },
    {
      "affs": [
        4
      ],
      "name": "Tokan Sultanaliyev"
    },
    {
      "affs": [
        4
      ],
      "name": "Irlan Sagandykov"
    },
    {
      "affs": [
        0
      ],
      "name": "Alexandr Fursov"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/0vdx57z8dcp8v.bib",
  "cited_by": 0,
  "doi": "10.3389/fcvm.2026.1959220",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672591/?tool=EBI",
  "id": "0vdx57z8dcp8v",
  "issns": [
    "2297-055X"
  ],
  "landing_url": "https://europepmc.org/article/PMC/PMC13672591",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2740|Cerebrovascular and Carotid Artery Diseases"
    ]
  ],
  "openalex": "W7215916303",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672591/pdf/?tool=EBI",
  "pmcid": "PMC13672591",
  "pmid": null,
  "published": "2026-10-02",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/0vdx57z8dcp8v.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:25Z",
      "native_id": "PMC:PMC13672591",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13672591"
    },
    {
      "first_seen": "2026-10-30T12:20:10Z",
      "native_id": "10.3389/fcvm.2026.1959220",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fcvm.2026.1959220/full"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "issn:2297-055X",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Subclavian-to-internal carotid artery bypass with carotid endarterectomy for total occlusion of the common carotid artery under awake neurologic monitoring: a case series",
  "title_text": "Subclavian-to-internal carotid artery bypass with carotid endarterectomy for total occlusion of the common carotid artery under awake neurologic monitoring: a case series",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:10Z",
  "url": "https://research.draconitic.com/paper/0vdx57z8dcp8v",
  "venue": "Frontiers in cardiovascular medicine",
  "versions": []
}