Cerebral protection with a crossover external carotid artery bypass during arch debranching.

Endovascular stent graft repair of the thoracic aorta sometimes requires debranching of the aortic arch and reimplantation of the left common carotid and left subclavian arteries to the brachiocephalic trunk. Cerebral protection has utmost importance during such a procedure. The surgical technique detailed here offers pulsatile flow inside the internal carotid arteries despite proximal clamping of the common carotid arteries throughout the whole procedure.