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There are reports that recurrent carotid stenosis after carotid endarterectomy though incidence of symptomatic carotid restenosis is less than 5%. Although various operative approaches have been attempted for recurrent carotid stenosis, a patch graft with a saphenous vein has been generally adopted. However, reoperation is technically more difficult because of the loss of normal anatomic planes, scar tissue involvement of adjacent nerves, and lack of cleavage plane requiring sharp dissection of the lesion. Recently, the authors performed a carotid-subclavian artery bypass with interposition saphenous vein grafts and proximal ligation of the internal carotid artery for recurrent stenosis of the common carotid artery with good results. The patient, a 58-year-old male, was admitted because of progressive hemiparesis and speech disturbance. About two years ago, he had undergone an endarterectomy for stenosis of both common carotid arteries. A carotid artery angiogram showed restenosis of the left common corotid artery and regional cerebral blood flow examination by 133 Xe also showed decreased blood flow in the left hemisphere. So, carotid-subclavian artery bypass with interposition saphenous vein grafts and proximal ligation of the the internal carotid artery were performed. Postoperatively, his hemiparesis and speech disturbance improved gradually. A postoperative subclavian artery angiogram demonstrated a patent bypass with excellent filling of the intracranial artery through the bypass.

surgery for cerebral stroke

Treatment of Recurrent Stenosis of the Common Carotid Artery by Combined Internal Carotid Artery Ligation and Carotid-subclavian Bypass with Interposition Saphenous Vein Grafts