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Updated: Dec 28, 2025
Bilateral Common Carotid Artery Occlusion as an Adequate Preconditioning Stimulus to Induce Early Ischemic Tolerance to Focal Cerebral Ischemia
Published on: May 9, 2013
Treatment of chronic internal carotid artery occlusion by ipsilateral external carotid endarterectomy
Yeshuai Hu1,2, Hai Qian2, Xiang'en Shi1,2
1Department of Neurosurgery, Fuxing Hospital, Capital Medical University, Beijing, P.R. China.
Insights
Endarterectomy of the external carotid artery (ECA) successfully treated a patient with chronic internal carotid artery (ICA) occlusion. This procedure led to improved symptoms and unexpected recanalization of both arteries.
Area of Science:
- Neurology
- Vascular Surgery
- Cerebrovascular Disease
Background:
- Chronic complete internal carotid artery (ICA) occlusion is a significant cause of ischemic cerebrovascular disease.
- Current treatment options include antithrombotic/anticoagulant agents and revascularization procedures, but optimal methods remain unproven.
Observation:
- A 50-year-old male presented with progressive left-sided weakness and cold sensation.
- Digital subtraction angiography revealed internal carotid artery occlusion and ipsilateral external carotid artery (ECA) stenosis.
- The patient's middle cerebral artery was compensated by the right ECA via the accessory meningeal and ophthalmic arteries.
Findings:
- Successful endarterectomy of the ipsilateral external carotid artery (ECEA) was performed.
- Postoperatively, the patient experienced significant symptom improvement.
- Remarkably, both the internal carotid artery and external carotid artery showed recanalization, with increased brain tissue metabolism.
Implications:
- External carotid endarterectomy (ECEA) may be an effective therapeutic option for select patients with chronic complete internal carotid artery occlusion.
- The unexpected recanalization suggests potential benefits beyond direct revascularization.
- Further research is warranted to evaluate the long-term efficacy and mechanisms of ECEA in ICA occlusion.
Abstract:
Chronic complete occlusion of the internal carotid artery (ICA) is a common and important cause of ischemic cerebrovascular disease, which can be treated in many ways: antithrombotic and anticoagulant agents, direct or indirect procedure for revascularization. However, there is still no evidence to prove which method is the most effective. Here we reported a case showed the successful endarterectomy of the external carotid artery (ECA) for a chronic complete occlusion of ICA patient. A 50-year-old male patient presented with progressively aggravated left-sided limb weakness and limb cold feeling. Digital subtraction angiography (DSA) showed ICA occlusion and ipsilateral ECA stenosis. The right ECA compensated for blood supply to the middle cerebral artery (MCA) through the accessory meningeal artery and ophthalmic artery. The patient was treated by endarterectomy of ipsilateral ECA (ECEA). In the second day after operation, the symptom was improved significantly. Surprisingly, both ICA and ECA were recanalized and the metabolism of the affected brain tissue was also increased. In conclusion, patients with chronic complete occlusion, ECEA would also be an effective therapeutic method.
