The Internal Carotid Artery With Chronic Complete Occlusion: Angiographic Evaluation
Chronic complete occlusion of the internal carotid artery is usually considered a contraindication to carotid endarterectomy in view of the very low rate of successful reconstruction. Our observation has shown, however, that a certain type of apparent complete occlusion in a small number of patients can be reconstructed with a relatively high rate of success. This particular type of occlusion is associated with a characteristic angiographic appearance. The involved internal carotid artery in these patients appears to be completely occluded about 7-10 mm distal to its origin, as opposed to occlusion exactly at the origin, which is typical for the inoperable complete occlusion. Five cases are reported with this type of potentially correctable occlusion. Successful reconstruction was achieved in three (60%) of these cases. The radiologist and particularly the vascular surgeon should be aware of and be able to recognize this condition so that proper management can be provided whenever indicated. Patho-physiologic explanation for this angiographic phenomenon is discussed.
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