A Mechanism-Based Classification of Mechanical Compression of the Extracranial Carotid Arteries: A Narrative Review

Mechanical external compression of the extracranial carotid arteries is a rare but potentially treatable cause of cerebral ischemia. Despite increasing reports of individual mechanisms, a unified and clinically applicable classification system is currently lacking. To propose a mechanism-based classification of mechanical carotid artery compression and to review the literature on diagnosis and management of this condition.

A narrative review of the literature was performed using PubMed/MEDLINE, Web of Science, and Google Scholar databases. Articles describing mechanical (extrinsic) compression of the extracranial carotid arteries were included. Cases were categorized according to the proposed mechanism-based classification: positional compression, compression by anatomical elements, and compression by volumetric formations. Our own previously published cases were incorporated as illustrative examples. The review primarily addresses compression of the internal carotid artery, with an additional discussion on common carotid artery compression.

A total of 55 articles were included. The proposed classification divides mechanical carotid compression into three main categories. Representative cases from each category, including our institutional experience, are presented along with diagnostic approaches and treatment strategies. Key clinical and imaging features of each mechanism are summarized.

Mechanical compression of the carotid arteries can be systematically classified according to the underlying mechanism. This classification may facilitate clinical recognition, diagnostic work-up, and individualized management. Increased awareness of these rare entities can lead to timely intervention and improved patient outcomes.