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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY

A Journal on Vascular and Endovascular Surgery


Official Journal of the Italian Society of Vascular and Endovascular Surgery
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Giornale Italiano di Chirurgia Vascolare 2001 September;8(3):231-41

language: English, Italian

Common carotid artery occlusion. Diagnosis and treatment

Appolloni A., Ronchey S., Castrucci T., Battistini M., Ippoliti A., Pistolese G. R.

From the Department of Vascular Surgery “Tor Vergata” University, Rome, Italy


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Background. The inci­dence of occlu­sion of the com­mon carot­id ­artery in ­patients ­with obstruc­tive ­lesions of the ­supra-aor­tic ­trunk var­ies ­between 1 and 5% and is usu­al­ly asso­ciat­ed ­with the occlu­sion of its branch­es. Nevertheless, in ­some cas­es ret­ro­grade revas­cu­lar­isa­tion ­from the exter­nal carot­id ­artery main­tains inter­nal carot­id ­artery paten­cy ­through the ­bulb. Surgical revas­cu­lar­isa­tion can be attempt­ed in ­these cas­es. The aim of ­this ­study was to eval­u­ate the diag­nos­tic ­tools and elec­tive sur­gi­cal tech­niques in ­these ­patients.
Methods. We ­reviewed 20 cas­es of com­mon carot­id ­artery occlu­sion. The neu­ro­log­i­cal symp­toms ­were main­ly hemo­dy­nam­ic. Duplex-­scan and angio­gra­phy ­were con­cor­dant in 18 cas­es. Of the two remain­ing cas­es, carot­id ­artery bifur­ca­tion paten­cy in one and carot­id ­axis paten­cy ­above innom­i­nate ­artery occlu­sion in the sec­ond ­were high­light­ed by ­duplex scan­ner. Ten ­patients ­were oper­at­ed: two aor­to-carot­id ­bypass, seven sub­cla­vian-carot­id ­bypass, one sub­cla­vian-sub­cla­vian ­bypass ­with reim­plan­ta­tion of the com­mon carot­id ­artery.
Results. One ­death ­from ­stroke due to cere­bral hyper­per­fu­sion syn­drome ­occurred in the post­op­er­a­tive peri­od. During the fol­low-up peri­od (aver­age 48 ­months) ultra­son­o­graph­ic con­trols evi­denced paten­cy of bypass­es and oper­at­ed carot­id arter­ies. No neu­ro­log­i­cal symp­toms ­occurred in the oper­at­ed ­patients. One ­patient ­died ­from myo­car­dial infarc­tion.
Conclusions. Duplex-­scan ­seems the ­most reli­able meth­od for the diag­no­sis of carot­id bifur­ca­tion paten­cy ­above an occlu­sion of the com­mon carot­id ­artery. Subclavian carot­id ­bypass is the tech­nique of ­choice in ­these cas­es ­with ­good imme­di­ate and ­late ­results.

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