Spontaneous recanalization of chronic internal carotid artery occlusions: report of 3 cases

Spontaneous recanalization of a chronically occluded internal carotid artery (ICA) is a rare occurrence. The authors report 3 patients who had documented total occlusion of the ICA followed by late spontaneous recanalization with subsequent high-grade stenosis. The patients in this series had occlusions for 11 months, 36 months, and 39 months, respectively. One patient had symptoms ipsilateral to the recanalized vessel, and 2 patients were asymptomatic. Endarterectomy was performed uneventfully in 2 patients and pathologic specimens demonstrated typical atherosclerotic plaque with patent lumens. Our experience demonstrates that although chronic recanalizations of occluded ICAs are rare, this does occur. Pathology demonstrates typical atherosclerotic plaque which appeared to have been recanalized by lysis of thrombus. The natural history of this condition is not well known and indications for intervention are not well established.