Color duplex sonography of occlusion of the common carotid artery with reversed flow in the extracranial internal carotid artery

Abstract

In a small percentage of cases with an occluded common carotid artery (CCA), the patency of the arteries beyond the carotid bulb is preserved. Color duplex sonography is useful for assessing blood flow in these vessels. We present a case of retrograde flow in an internal carotid artery (ICA) with an occluded ipsilateral CCA identified using color duplex sonography in a 70-year-old man with diabetes and known atherosclerotic disease. Color duplex sonography revealed that the right CCA was totally occluded near its origin and that flow was re-established at the bulb. Flow in the right ICA was directed cephalad, with a low-frequency, damped waveform; flow in the right external carotid artery (ECA) was bidirectional, with increased reversed diastolic flow. Extensive atherosclerotic lesions were also found in the left side. Endarterectomy of the left carotid bifurcation was performed. Follow-up color duplex sonography 3 months later revealed a small increase of stenosis in the left CCA and mild stenosis in the left ICA. The right CCA remained occluded, but reversed flow with a high-resistance flow pattern was seen in the ipsilateral ICA that supplied the ECA, which had cephalad-directed flow.

Emergency Surgical Revascularization in a Patient with Acute Symptomatic Common Carotid Artery Occlusion

“…Although the incidence of an isolated CCA occlusion in acute stroke patients is low, it is associated with an extremely high risk of recurrent ischemic events due to both repeated post-occlusive thromboembolic events and insufficient cerebral hemodynamics [1] , stressing the importance of rapid identification of this potentially devastating disorder. Comparable with other previous case reports [3,4] , extracranial and transcranial color-coded duplex sonography was effective in visualizing the patent distal vessels in the presence of a CCA occlusion. In our patient, a minimal residual anterograde flow in the ICA was preserved by a retrograde flow from the ECA into this vessel, whereas in the face of a reduced basilar artery flow due to a high-grade stenosis at the origin of the left VA and hypoplasia of the opposite VA the intracranial collateral flow was insufficient to maintain an adequate blood supply to the left hemisphere, as evidenced by additional CT perfusion imaging.…”

The Pitfalls and Important Distances in Temporal Bone HRCT of the Subjects with High Jugular Bulbs – Preliminary Report

“…1. The mastoid volume values were 21.42 ± 11.81 mm 3 in the bilateral HJB group, 33.0 ± 19.54 mm 3 in the unilateral HJB group, and 32.96 ± 20.57 mm 3 in the control group. There was no significant difference between groups (p < 0.05).…”

“…Abnormal bone formation, an aberrant sigmoid sinus and jugular system, or decreased pneumatization of the mastoid bone may predispose the ear to its occurrence. In some cases, this condition may be asymptomatic [3].…”

Common Carotid Artery Occlusion With Retrograde Flow in the Internal Carotid Artery

“…Given the complete occlusion of the right CCA, it is likely that the blood flow pathway is antegrade up the left ICA and through the carotid siphon into the anterior cerebral artery, then across the AComA and reversed through the right anterior cerebral artery, ultimately reversing through the right carotid siphon and ICA to supply the right ECA ( Figure 9). A potential alternate pathway is retrograde collateral filling of the intracranial ICA via the basilar artery and PComAs 7,8 ; however, in the case presented, the posterior circulation was seen to be noncontributory due to an apparent functionally incomplete circle of Willis, with very small or hypoplastic PComAs, forcing the remaining patent anterior circulation to be the source for collateral flow. This would also explain the severity of the patient's symptoms and ultimate death secondary to severe stroke.…”

“…1,10 CCA occlusion is detected in 2% to 5% of the population with cerebrovascular disease. 2,3,7,9,[10][11][12][13] There is little information about the clinical features, neurologic symptoms, etiologies, and pathogenesis of CCA occlusion. 3 Patients who have CCA occlusion can present clinically with a wide range of symptoms, from asymptomatic to severe stroke, and CCA occlusion is not necessarily associated with cerebral infarction or even measurable brain dysfunction.…”