Internal Carotid Artery Patency following Common Carotid Artery Occlusion: Management of the Asymptomatic Patient

Abstract While revascularization of the acutely or chronically occluded internal carotid artery has become commonplace with modern endovascular techniques, revascularization of an acutely occluded common carotid artery (CCA) is a controversial procedure with unique challenges. These challenges can be related to the lack of observable markers for identifying vessels during navigation or for identifying the exact location and extent of occlusion within the CCA, in addition to wide-ranging treatment risks. In this video, we illustrate the controversial revascularization of a 68-yr-old woman with an acute CCA occlusion who presented with fluctuating neurological symptoms. We believed treatment to be indicated by the lack of adequate collaterals on the intracranial CTA, and fluctuating symptoms in the absence of an intracranial major vessel occlusion, suggesting that the CCA occlusion was exerting important hemodynamic effects and at risk of causing a major stroke without revascularization, despite a low initial NIH stroke score. Though acute recanalization of patients with low NIH stroke score with stent-angioplasty is a controversial procedure, we believed it to be necessary in the case of our patient and believe it will likely be the focus of the next wave of large clinical trials dedicated to acute stroke.

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The role of common carotid artery end-diastolic velocity in near total or total internal carotid artery occlusion

European Journal of Vascular and Endovascular Surgery ◽

10.1016/s1078-5884(96)80042-6 ◽

1996 ◽

Vol 11 (2) ◽

pp. 140-147 ◽

Cited By ~ 13

Author(s):

A.E. Androulakis ◽

N. Labropoulos ◽

R. Allan ◽

T.K. Tyllis ◽

A.Al. Kutoubi ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Common Carotid Artery ◽

Internal Carotid ◽

Artery Occlusion ◽

Carotid Artery Occlusion ◽

Internal Carotid Artery Occlusion ◽

Diastolic Velocity

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Subclavian Artery to Internal Carotid Artery Interpositional Bypass for Carotid Artery Occlusion: Technical Case Report

Operative Neurosurgery ◽

10.1093/ons/opaa263 ◽

2020 ◽

Vol 20 (1) ◽

pp. E66-E71

Author(s):

Joshua S Catapano ◽

Fabio A Frisoli ◽

Gabriella M Paisan ◽

Katherine A Dunn ◽

Ankush Bajaj ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Radial Artery ◽

Subclavian Artery ◽

Common Carotid Artery ◽

Internal Carotid ◽

Artery Occlusion ◽

Carotid Artery Occlusion ◽

Radial Artery Graft ◽

Artery Graft

Abstract BACKGROUND AND IMPORTANCE Conventional microsurgical treatment for symptomatic internal carotid artery (ICA) occlusion is revascularization with superficial temporal artery (STA) to middle cerebral artery bypass. However, in rare cases where the common carotid artery, external carotid artery (ECA), or both are also occluded, other microsurgical treatment options must be considered. CLINICAL PRESENTATION We present the case of a 52-yr-old woman with common carotid artery occlusion and weak ICA flow from collateral connections between the vertebral artery, occipital artery, and ECA. She had ischemic symptoms and a history of stroke. The patient's STA was unsuitable as a donor vessel due to its small caliber and poor flow, and we instead performed an interpositional bypass from the subclavian artery to the ICA using a radial artery graft. CONCLUSION This case illustrates the successful use of the subclavian artery to ICA bypass technique with an interpositional radial artery graft. The surgical anatomy of the subclavian arteries is reviewed, and the technical details of subclavian artery to radial artery graft to ICA interpositional bypass are presented.

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