The patient was operated by me 21-October-2012 for complete stenosis left ICA. The patient was sent the the ICU and doing OK. After 12 hours, he showed deterioration of his right sided paresis till deep paresis of the right upper limb with the right side of the face with speech difficulty. The heparinization protocol was intensified and repeat CT-scans did not show any changes. CT-angio done showing occlusion of the left ICA.

The wound was opened and the ICA dissection was extended superior. The ICA is pulsating, but weaker than the ECA and CCA. The Javid shunt was occluded from its long side  and the shorter side was inserted to the ICA above the graft through a vertical incision around 10 mm. The flow from the grafted side was excellent, but from the cranial side was zero. Angiography was done showing good filling of the left MCA and ACA. The balloon was inflated and withdrawn  with the thrombus and debris outside the artery. The same procedure was done with the log end of the Javid shunt. No more thrombi. The flow was excellent from above and angiography repeated another time to show good filling of the left MCA and ACA and most of the ICA. The arterial defect was closed using 5 zero nylon suture.

Routine closure of the wound. Smooth postoperative recovery with same neurologic deficit as before the second surgery.

The patient progressed thrombosis above the grafted area several hours after surgery. Opening the wound and meticulous cleaning of the thrombus is the best option.