Common Carotid Artery Occlusion Treatment: Revealing a Gap in the Current Guidelines

Abstract

The necessity to intervene to a CCAO remains controversial. This review shows that open surgical management of symptomatic CCA occlusive disease is a safe, durable, and effective therapeutic strategy with low perioperative cerebrovascular morbidity.

Evaluation of revascularization after total arch replacement in common carotid artery occlusion

“…Cerebral dysfunction with ischemia may be connected to cytokines, prostanoids, and nitric oxide release[ 7 ]. In addition, the majority (92.7%) of patients treated were symptomatic[ 1 ]. Although most patients with patent bifurcation presented with amaurosis fugax and vertigo attacks, no patients with patent distal vessels and well-functioning intracranial collaterals had a major stroke.…”

“…Angiography is often performed to diagnose these types. However, we were not able to obtain detailed information such as collateral filling and flow[ 1 ]. Color duplex sonography is a sensitive method for estimating the dynamic pattern of collateral flow to reconstitute a patent carotid bifurcation and is the hallmark for detecting a patent ICA despite CCAO[ 5 , 10 ].…”

“…However, SPECT, which was used to perform the quantitative evaluation of actual brain perfusion, showed collateral blood flow insufficiency. Even if collateral flow is maintained, patients with neurological symptoms need to undergo quantitative evaluation of perfusion in the brain because there may be insufficiency[ 1 ].…”

“…The aim of surgical treatment is to therapeutically improve brain circulation and functionality in patients with cerebral insufficiency due to CCAO. Klonaris et al[ 1 ] reported that all patients undergoing surgery for transient nonhemispheric symptoms due to circulatory insufficiency experienced resolution of their symptoms after the procedure. Although we observed improved neurological symptoms without SPECT, we should aggressively estimate and treat low cerebral flow when it is related to neurological symptoms.…”

“…Occlusion of the common carotid artery (CCA) is rare. It occurs in 2%-4% of patients undergoing angiography for symptomatic cerebrovascular disease[ 1 ]. The natural history of the disease is unknown; therefore, certain parameters such as distal vessel patency and the presence of symptoms may affect treatment decisions[ 1 ].…”