Carotid-carotid bypass with novel bilateral extracorporeal carotid shunting: A hybrid open and endovascular technique.

Carotid-carotid bypass is a revascularization option for symptomatic proximal carotid or innominate artery occlusive disease. We report the case of a 77-year-old woman with innominate in-stent occlusion who sustained an acute right hemispheric stroke during hospitalization. Cerebral angiography demonstrated that the right hemisphere was perfused solely through a circuitous, stenotic vertebrobasilar collateral pathway, with absent anterior crossflow, making carotid clamping immediately catastrophic. A three-way extracorporeal shunting circuit-established under fluoroscopic guidance before carotid clamping-maintained continuous bilateral internal carotid perfusion during simultaneous carotid clamping and carotid-carotid bypass, achieving zero cerebral ischemia time. The patient remained neurologically intact at discharge.