Abstract:Ischemic neurological symptoms are sometimes caused by stenotic or occlusive lesions of the major arterial trunks arising from the aortic arch. The indication for surgical repair of such lesions is the failure of medical treatment to prevent ischemic episodes. Cerebral blood flow studies can aid in selecting patients for surgical treatment. Direct repair by endarterectomy or grafting is the preferred method of treatment. Arterial origin stenosis can be treated by dividing the artery distal to the lesion and reimplanting it into a healthy artery. Bypass grafts used to treat these lesions include aorta to brachiocephalic trunk, aorta to subclavian artery, aorta to common or internal carotid artery, carotid to subclavian artery, subclavian or brachiocephalic to carotid artery, and carotid to vertebral artery. Excellent results can be achieved in carefully selected patients. Avoiding simultaneous procedures can minimize morbidity and mortality. Endovascular techniques are likely to play a greater role in the future.