Purpose: This is a retrospective study of 16 patients who had an average of 3.25 arteries supplying the brain that were occluded or severely diseased. In all of them severe disease or occlusion of the left carotid and subclavian arteries precluded an ipsilateral repair. Methods: These patients with extensive extracranial arterial disease underwent revascularization from the opposite side of the neck through a retropharyngeal tunnel. Twelve patients had contraindications for a transthoracic repair. Results: There were no early deaths. Postoperative complications included one graft occlusion, one anastomotic disruption with hemorrhage, and one stroke, all resulting from management errors. follow-up was 100%. Primary patency rate was 94%, and survival was 87.5%. Two patients died in the interval: one from a myocardial infarction and one from cause unknown. Conclusions: The retropharyngeal route is a shorter and more direct path across the neck and occasionally permits direct carotid-to-carotid transposition without the use of prosthetic bypasses. Even in the presence of extensive extracranial disease, these reconstructions have an excellent patency rate, and these patients have a survival 87.5% after a mean follow-up of 5.56 +/- 4.0 years.
