Carotid ligation for recurrent ischemia due to inaccessible carotid obstruction

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Abstract
Experiences with a patient with symptomatic obstruction of the carotid artery in its petrous segment are described. In spite of the severe stenosis of this vessel, complete cerebral arteriography demonstrated excellent perfusion of the symptomatic eye and hemisphere and an ample collateral reserve. Funduscopy confirmed the clinical impression that recurrent retinal and hemispheric ischemia in this patient was the result of microembolism rather than intracranial hemodynamic insufficiency. Extracranial-intracranial (EC-IC) bypass offered little benefit to this patient. Abrupt ligation of the internal carotid artery in the neck was effective in arresting the embolic discharge from this vessel''s inaccessible obstruction and resulted in prompt and complete relief of ischemic symptoms. Identifying the mechanism(s) responsible for recurrent ischemia past uncorrectable carotid obstructions is important in establishing the most appropriate treatment(s). Carotid occlusion is an effective surgical remedy for terminating microembolism from this vessel when it is diseased and incompletely obstructed and should be considered in selected patients. The importance of angiographic evaluation of naturally occurring EC-IC anastomotic connections and the assessment of intracranial collateral reserves in cases of carotid occlusion are emphasized.