Unilateral brachial artery antegrade selective cerebral perfusion following carotid endarterectomy for carotid, coronary, and aortic aneurysmal surgery

Abstract   In the presence of multiple concomitant occlusive and aneurysmal diseases, selection of the brain protection method is a primary concern. A case with a disease triad of stenotic lesions in internal carotid arteries, coronary artery atherosclerosis, and an ascending-arcus aorta aneurysm is presented. We simultaneously performed right carotid endarterectomy, coronary artery bypass grafting, and graft replacement of the ascending-arcus aorta. Brain protection was achieved with continuous right brachial artery antegrade selective cerebral perfusion under moderate hypothermia, following carotid endarterectomy. The operative technique is detailed and antegrade selective cerebral perfusion following the carotid endarterectomy for aneurysmal surgery is discussed.