Abstract
Innominate artery occlusive disease (IAOD) is an uncommon yet significant cause of cerebral and upper extremity ischemia, often requiring revascularization. We present a case series of patients with symptomatic IAOD managed with carotid-to-carotid bypass, highlighting three distinct clinical scenarios, including failed prior endovascular intervention, extensive supra-aortic trunk calcification, and high surgical risk prohibiting sternotomy. Our findings emphasize key considerations in IAOD management, including patient selection, technical feasibility, and long-term outcomes of extra thoracic revascularization. Despite complex comorbidities, carotid-to-carotid bypass provided sustained symptom relief and graft patency in our cohort. A patient-centered approach remains essential for optimizing outcomes in this population.