Common Carotid Artery Occlusion: A Single-Center Experience in 40 Cases

Abstract

artery occlusion (CCAO) has been little discussed in the literature compared with occlusion of the internal carotid artery (ICA). However, CCAO seems to be a different disease because of its presentation, treatment, and incidence.CCAO is diagnosed in approximately 3% of the symptomatic patients undergoing carotid angiography 1 and in only 1 to 5% of the patients with symptomatic cerebrovascular disease. 2,3 The development of exuberant collateral circulation and patency of the carotid bifurcation seems to protect against ischemic brain lesions. 3 However, several symptoms can occur, including hemispheric stroke, amaurosis fugax, and brain hypoperfusion. 2 To date, no consensus exists for treatment of asymptomatic patients, and decisions for treatment of symptomatic patients are controversial and made according to each case. 4The incidence of common carotid artery occlusion (CCAO) is approximately 3% in patients who undergo angiography for symptomatic cerebrovascular disease; however, few studies have reported on management of this condition. The objective of this article was to analyze risk factors, therapeutic options, and clinical benefits of surgical treatment at a hospital in the city of São Paulo, Brazil. Data were collected from medical records of 40 patients with CCAO who were treated from June 2002 to October 2013. Results were analyzed retrospectively. Most of the patients were men (63.0%), who were significantly younger than women. Most of the participants had hypertension (90.0%), and more than half had a history of smoking (52.5%). The mean number of coexisting comorbidities/risk factors was 2.9 AE 1.0. Half of our sample had ipsilateral patent internal and external carotid artery, and 32.5% presented with an occluded internal carotid artery and a patent external artery. Patients with both an internal and an external occluded carotid artery (12.5%) were significantly older. Contralateral arteriosclerosis was observed in 65% of the patients, mainly represented by 50 to 90% stenosis. Most patients were symptomatic (67.5%), and hemiparesis was the most common symptom (55.0%) found. Most (77.5%) of the patients underwent the medical treatment; one out of three endovascular approaches failed. During the mean follow-up of 55 AE 43 months (range, 2-136 months), 17.5% of the patients died within 4 days after surgical repair and after along 123 months of clinical follow-up. Coexisting comorbidities/risk factors were significantly associated with fatal outcomes, such as acute myocardial infarction. This study provides scientific evidences on treatment and outcomes of CCAO.

Blunt carotid injury with thrombotic occlusion: Is an intervention always required for best outcome?

“…In fact, indications of stenting have been narrowed down to enlarging pseudoaneurysms and dissection with near-complete stenosis [14,15]. A review of patients undergoing CCA revascularization in the non-traumatic population also concluded that the benefits of traditional treatments in asymptomatic patients are uncertain [16].…”

Symptomatic Bilateral Carotid Artery Occlusion: An Uncommon Pattern of Carotid Pathology

“…The collateral circulation consists mainly from the vertebrobasilar system with cross-filling of the middle cerebral artery through the circle of Willis or through an ECA-ophthalmic artery anastomosis. Patients who occlude their carotid artery may present asymptomatic, especially if they have gradually developed an excessive collateral network, although the majority of such patients is symptomatic according to recent pooled data [ 2 , 8 ]. In the acute setting, most of them experience neurological defects ranging from amaurosis fugax or transient ischemic attack to a major disabling stroke.…”

“…Endovascular recanalization has been described in limited cases as well. This is justified as chronic atherosclerotic plaques are usually calcified and guidewire and emboli protection devices may not be possible to cross the lesion [ 2 , 8 ]. We believe that this therapeutic approach should be considered only in extremely high-risk patients and by endovascular surgeons/ interventional specialists who have large experience.…”

Acute visual loss as the first ocular symptom in a Sjögren’s syndrome patient with bilateral common carotid artery occlusion: a case report

“…Common carotid artery occlusion (CCAO) is a rare condition and is diagnosed in about 3% of symptomatic patients with cerebrovascular disease [ 5 ]. The risk factors of CCAO include hypertension (HTN), a history of smoking, and diabetes mellitus (DM) [ 6 , 7 ]. The blood supply to the eye stems from the common carotid artery, thus, a CCAO can present with ocular ischemic syndrome (OIS) [ 8 ].…”