Intracranial Circulation in Carotid Occlusion

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Abstract
For many years it has been known that neurological deficit and cerebral infarction do not invariably follow occlusion of the carotid artery. It is probable that the development of stroke in patients with carotid occlusion is due to a variety of coexisting abnormalities of the intracranial or systemic circulations. As early as 1914, Hunt1 suggested that the severity of symptoms following carotid occlusion depended upon the presence of various factors including heart disease, extension of the thrombus into the cerebral vessels, and adequacy of collateral channels especially the communicating arteries of the circle of Willis. To these must be added forward embolization from the carotid thrombus or atherosclerotic lesion,2-6 independent cerebral artery occlusion,7-10 and occlusive disease of the remaining extracranial arteries to the brain.9,11,12 In the present investigation the incidence, type, and significance of each of these abnormalities have been reviewed in a group of 61