High-Flow Bypass with Vertebral Artery (V3) to Middle Cerebral Artery (M2) Bypass Using Radial Artery Graft for Common Carotid Artery Occlusion

Common carotid artery (CCA) occlusion is a rare condition that can result in diverse neurological symptoms due to insufficient cerebral blood flow. We present a case of CCA occlusion treated with high-flow vertebral artery (VA) to middle cerebral artery (MCA) bypass using a radial artery (RA) graft. A 68-year-old man experienced recurrent ischemic events in the months preceding surgery. Preoperative diffusion-weighted imaging showed left anterior border zone infarction, and single-photon emission computed tomography revealed severe hemispheric hypoperfusion. Digital subtraction angiography confirmed complete occlusion of the left CCA with inadequate external carotid artery (ECA) supply. A VA (V3 segment)-RA-MCA (M2 segment) bypass was performed, resulting in an uneventful postoperative course. Follow-up angiography demonstrated durable patency of the radial artery graft. No recurrent ischemic events were observed during the 2-year follow-up period. This technical note demonstrates key surgical considerations for VA-RA-MCA high-flow bypass as a salvage technique in a patient with symptomatic CCA occlusion.