External carotid angioplasty in the treatment of developing stroke

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Abstract
Percutaneous transluminal angioplasty (PTA) is gradually becoming accepted as a method of treatment for internal and common carotid stenoses, although the exact indications, risks and outcomes have not yet been determined (Brown et al, 1990). Angioplasty of atherosclerotic stenoses of the external carotid artery has been performed less often. We present a case where a patient developed increasing hemiparesis since much of the left cerebral circulation was supplied from a stenosed external carotid artery and collaterals. The left internal carotid artery was occluded and the right internal carotid stenosed. The patient's symptoms improved markedly following PTA of the left external carotid artery. A 76-year-old woman presented with a 2 month history of slurred speech and increasing weakness of the right arm and leg. She was a lifelong smoker. On examination she was dysarthric, normotensive and in sinus rhythm. The heart sounds were normal but there were bilateral high pitched carotid bruits. On the right side there was mild weakness of the arm and leg, an increased ankle jerk and an extensor plantar reflex. Cranial nerve assessment was normal. Carotid angiography demonstrated complete occlusion of the left internal carotid and a severe stenosis at the orgin of the left external carotid artery (Fig. 1).