Bypass Surgery for Occluded Internal Carotid Artery Revascularized by Vasa Vasorum. Case Report.

Abstract

A 47-year-old woman presented with two transient ischemic attacks due to occlusion of the left internal carotid artery. The affected artery was revascularized by vasa vasorum. Angiography showed occlusion of the left common carotid artery including the origin of the internal carotid artery. The distal internal carotid artery was revascularized by vasa vasorum at the level of the second cervical vertebral body. Left subclavian artery-internal carotid artery bypass surgery using a saphenous vein graft was performed successfully, during which the narrowed but patent lumen of the internal carotid artery was confirmed. Follow-up angiography showed enlargement of the left internal carotid artery distal to the patent bypass. Reconstructive bypass surgery is a possible treatment for patients with occluded internal carotid artery revascularized by vasa vasorum. Angiographic detection of the lumen of the internal carotid artery is important for surgical consideration.

Recanalisation of the internal carotid artery via the vasa vasorum after coil occlusion

“…It has been recognised that the vasa vasorum in the cervical carotid artery originate from the external carotid artery and internal carotid artery near the carotid bifurcation [3,5]; however, recanalisation of an occluded cervical internal carotid artery via the vasa vasorum is very rare. There have been only a few reported cases [5][6][7][8][9][10][11][12].…”

“…There have been only a few reported cases [5][6][7][8][9][10][11][12]. Among most of the reported cases, the cause of internal carotid artery occlusion was atherosclerosis.…”

“…Atherosclerotic changes cause an increase in the vasa vasorum, which form a dense vascular network within the plaque [3,4], and vessels originating from the arterial lumen may develop and communicate with the vasa vasorum [3,5]. However, after complete occlusion of the internal carotid artery (ICA), recanalisation via the vasa vasorum is rare, with only a few reported cases [5][6][7][8][9][10][11][12].We describe a case of recanalisation of the ICA occluded by endovascular coiling. It seems that collateralisation via the vasa vasorum developed in the 3 year follow-up period.…”

“…The vasa vasorum supply the arterial blood to the adventitia and outer third of the media in large arteries, whereas diffusion across the endothelial layer supplies oxygen and other nutrients to the endothelium and inner media [1,2]. Atherosclerotic changes cause an increase in the vasa vasorum, which form a dense vascular network within the plaque [3,4], and vessels originating from the arterial lumen may develop and communicate with the vasa vasorum [3,5]. However, after complete occlusion of the internal carotid artery (ICA), recanalisation via the vasa vasorum is rare, with only a few reported cases [5][6][7][8][9][10][11][12].…”

"Pseudostring Sign" on Carotid Computed Tomographic Angiography

“…The reconstituted distal ICA can also be a potential target for extracranial bypass revascularization. 10 …”