Peripheral Vascular Surgery Society

John C. Hansen, MD, David L. Cull, MD, Spence M. Taylor, MD,

Eugene M. Langan, III, MD, Bruce A. Snyder, MD and Cindy B.Coffey, RVT

Greenville Hospital System, Greenville, SC

Common carotid artery occlusion (CCAO) is usually associated with occlusion of the internal carotid artery (ICA). Rarely, ICA patency is maintained following CCAO through collateral flow of the ipsilateral external carotid artery or an aberrant ICA branch. Several small series report excellent results of ICA revascularization in relieving cerebral ischemic symptoms in these patients. The natural history of CCAO with patent ICA, however, in the asymptomatic patient is unknown.

The vascular registry and carotid duplex scans from January 1994 through December 1997 were reviewed. Data collection included chart review, phone interviews, and the review of angiogram and duplex scans.

Asymptomatic CCAO with patent ICA was identified in 7 patients. There were 2 males and 5 females with a mean age of 63 years (range 50-73 yr.). Duplex scan correctly established the diagnosis of CCAO with patent ICA in 83% of cases (5/6). Angiography correctly established the diagnosis in 40% of cases (2/5). Five patients were followed non-operatively and two patients underwent ICA revascularization. With complete follow-up ranging from 6 months to 84 months (mean 35 months), all patients have remained asymptomatic.

Of the two operative cases, one thrombosed an aorta-ICA bypass after a perioperative myocardial infarction but suffered no neuropathic complications and remains asymptomatic with a patent ICA at 27 months follow-up. Another patient underwent successful carotid subclavian bypass and remains asymptomatic at 6 months.

This study suggests that carotid duplex is more sensitive for detecting ICA flow after CCAO than contrast angiography. It also suggests that while rare in presentation, asymptomatic patients with CCAO and a patent ICA appear to have a benign neurologic course and can probably be followed without a high risk of stroke.