Diagnostic and therapeutic alternatives in patients with symptomatic “carotid occlusion” referred for extracranial-intracranial bypass surgery

Abstract

An increasing number of patients with sympatomatic carotid artery occlusion are being referred for extracranial to intracranial bypass grafts. After careful clinical and angiographic assessment, a number of these patients were treated with a direct approach to the carotid arteries in the neck or with anticoagulation rather than with a bypass graft. These patients may be categorized diagnostically under the following headings: complete occlusion of the internal carotid artery (ICA) with intracranial patency; spontaneous dissection of the ICA; atheromatous pseudo-occlusion; carotid artery occlusion with stenosis of the contralateral ICA; occlusion of the ICA and stenosis of the external carotid artery and thrombus in the intracranial segment of an occluded ICA. Each of these categories is discussed briefly, and illustrative cases are presented.