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Online ISSN 1827-1847
Appolloni A., Ronchey S., Castrucci T., Battistini M., Ippoliti A., Pistolese G. R.
From the Department of Vascular Surgery “Tor Vergata” University, Rome, Italy
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.
language: English, Italian