We report the case of a 67 year old English woman with bilateral transient cerebral ischaemic attacks who was managed by unconventional surgery. Duplex ultrasound of the carotid bifurcations indicated complete occlusion of the left common carotid artery with retrograde flow from external to internal carotid artery and an ulcerated plaque at the external carotid artery origin. Following ligation of the external carotid artery origin to exclude the ulcerated plaque, the proximal external carotid artery was re-anastomosed to the internal carotid artery, preserving cephalad flow in the internal carotid artery. This case report provides additional insight into the cause of transient ischaemic attacks and offers an innovative surgical solution which preserves blood flow to the brain. It also emphasises the need for an open minded and innovative approach to vascular surgery.
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