External carotid artery in internal carotid artery occlusion. Angiographic, therapeutic, and prognostic considerations.

Publisher Website
Google Scholar
Abstract
Instances (23) of internal carotid artery occlusion occurring with minimal neurological deficit in 22 patients are described. Although each was referred to the neurosurgical service for evaluation for an extracranial-intracranial microvascular bypass procedure, complete arteriographic evaluations of their cerebrovasculature suggested that alternative methods should be the treatment of choice. For each patient the ipsilateral external carotid artery was demonstrated by angiography to be an important source of collateral blood supply to the cerebral hemispheres or retinae distal to the occluded internal carotid arteries. Ten patients with no significant atherosclerotic narrowing or ulceration of the external carotid artery remained free of symptoms of cerebral ischemia for 6-40 mo. In 12 patients who developed delayed recurrent cerebral or retinal ischemia ipsilateral to their internal carotid artery occlusion, obstructive and/or ulcerative plaques involving the common and/or external carotid arteries occurred. Thromboendarterectomy in 11 patients gave complete relief of ischemic symptoms during the 4-36 mo. of postoperative follow-up. Of these 12 patients 1 refused operation and developed a major cerebral infarction. Angiographic identification of a functionally important external carotid artery ipsilateral to an internal carotid artery occlusion carries considerable prognostic and therapeutic significance.