62 year old female with unresectable nasopharyngeal carcinoma. The right common carotid artery was sacrificed after development of an oral cutaneous fistula. The left common carotid was almost occluded and could not be repaired surgically due to postradiation changes. Bypass grafts are normally performed using the superficial temporal artery, but this was not available in this patient due to the near occlusion of the common carotid. A saphenous vein bypass from the left subclavian artery to the distal left middle cerebral artery was performed (images below). A week later, a proximal right common carotid artery stump to distal middle cerebral artery bypass was done with another saphenous vein. The right side graft had to be reopened a month after surgery, but otherwise the patient was without cerebral ischemia symptoms until her death.
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Case #1aLateral selective left subclavian graft angiogram The left saphenous vein to distal middle cerebral artery graft is demonstrated with excellent filling of the intracerebral artery branches. |
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Case #1bAP selective left subclavian graft angiogram The left saphenous vein to middle cerebral artery end-to-side anastomosis (arrow) with filling of the anterior and middle cerebral artery group. Note the filling of the lenticulostriate circulation. |