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Middle Cerebral Artery Occlusion Allowing Reperfusion via Common Carotid Artery Repair in Mice
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Evaluation of revascularization after total arch replacement in common carotid artery occlusion

Yasuhiro Matsuda1, Tadaaki Koyama1

  • 1Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Hyogo 650-0047, Japan.

World Journal of Clinical Cases
|January 30, 2018
PubMed

Insights

Common carotid artery occlusion (CCAO) is rare. SPECT imaging revealed insufficient brain perfusion, necessitating bypass surgery which successfully improved symptoms and cerebral blood flow.

Area of Science:

  • Vascular Surgery
  • Neurology
  • Diagnostic Imaging

Background:

  • Common carotid artery occlusion (CCAO) is a rare condition.
  • Symptoms can include drowsiness and hemiplegia, often linked to emboli post-cardiac surgery.
  • Initial assessment using color duplex sonography may be insufficient in cases with retrograde or collateral flow.

Observation:

  • A patient presented with symptoms suggestive of CCAO after total arch replacement.
  • Color duplex sonography showed retrograde flow, initially suggesting adequate collateral circulation.
  • Single-photon emission computed tomography (SPECT) revealed quantitatively insufficient brain perfusion and collateral blood flow.

Findings:

  • A left subclavian artery to left common carotid artery bypass was performed to enhance brain perfusion.
  • Postoperatively, the patient's epilepsy and drowsiness resolved, and right hemiplegia significantly improved.
  • SPECT imaging demonstrated increased left cerebral blood flow, with an improved asymmetry ratio from 71% to 81%.

Implications:

  • Color duplex sonography alone is insufficient for evaluating CCAO with retrograde or collateral flow.
  • Quantitative evaluation using SPECT is crucial for accurate assessment of brain perfusion in CCAO.
  • Prompt surgical intervention, like bypass grafting, can effectively restore cerebral blood flow and improve neurological deficits.

Keywords:
Color duplex sonographyCommon carotid artery occlusionRevascularizationSingle-photon emission computed tomographyTotal arch replacement

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