Subclavian-to-internal carotid artery bypass with carotid endarterectomy for total occlusion of the common carotid artery under awake neurologic monitoring: a case series
5 affiliations
- 1Professor G. V. Tsoi Scientific and Educational Center of Surgery, NJSC “Astana Medical University” , ,
- 2Scientific Research Institute of Radiobiology and Radiation Protection, NJSC “Astana Medical University” , ,
- 3Department of Interventional Radiology, CF University Medical Center , ,
- 4Clinical Academic Department of Anesthesiology and Intensive Care, CF University Medical Center , ,
- 5Center for Vascular and Reconstructive Surgery, National Research Oncology Center , ,
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.
Objective: 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.
Methods: 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.
Results: 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.
Conclusion: 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.
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BibTeX
@article{dogalbayev2026subclaviantointernal,
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}},
author = {Yerbol Dogalbayev and Kuralay Ilbekova and Ruslan Tukinov and Gulnar Mustafinova and Nurlan Azimzhanov and Seilbek Beketov and Didar Kadyrbek and Tokan Sultanaliyev and Irlan Sagandykov and Alexandr Fursov},
journal = {Frontiers in cardiovascular medicine},
year = {2026},
month = oct,
doi = {10.3389/fcvm.2026.1959220},
url = {https://europepmc.org/article/PMC/PMC13672591},
note = {CC BY},
}
RIS
TY - JOUR
TI - Subclavian-to-internal carotid artery bypass with carotid endarterectomy for total occlusion of the common carotid artery under awake neurologic monitoring: a case series
AU - Yerbol Dogalbayev
AU - Kuralay Ilbekova
AU - Ruslan Tukinov
AU - Gulnar Mustafinova
AU - Nurlan Azimzhanov
AU - Seilbek Beketov
AU - Didar Kadyrbek
AU - Tokan Sultanaliyev
AU - Irlan Sagandykov
AU - Alexandr Fursov
PY - 2026
DA - 2026/10/02
JO - Frontiers in cardiovascular medicine
DO - 10.3389/fcvm.2026.1959220
UR - https://europepmc.org/article/PMC/PMC13672591
AB - 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. Objective: 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. Methods: 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. Results: 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. Conclusion: 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.
SN - 2297-055X
ER -