A Case of Extra-anatomical Bypass for Brachiocephalic Artery Aneurism Causing Recurrent Cerebral Infarction

Abstract

A 74-year-old man with paralysis of the left upper limb presented to our hospital. Magnetic resonance imaging (MRI) revealed scattered cerebral infarctions in the right hemisphere. The patient’s symptoms improved rapidly, so he returned home without hospitalization at his own request. However, 15 days after the initial onset, paralysis of the left upper limb recurred, and the patient was hospitalized. MRI showed new lesions in the same hemisphere, and contrast-enhanced computed tomography (CT) revealed brachiocephalic artery (BCA) aneurysm and occlusion of the right subclavian artery (RSCA). The BCA aneurysm contained extensive atheromatous plaque, which was considered to be the cause of the cerebral infarctions; thus, we determined that surgical intervention was necessary to prevent the recurrence of cerebral infarctions. Endovascular treatment was deemed unsuitable because of the high risk of embolization. Therefore, a bypass between the bilateral axillary arteries was constructed, the right common carotid artery (RCCA) was ligated, and an extra-anatomical bypass was performed from the previous bypass to the RCCA. The patient was discharged home on the 7th postoperative day. Six months later, no recurrence of cerebral infarctions has been observed.