Occluded but nonthrombosed internal carotid artery: an indication for endarterectomy

The indications for carotid endarterectomy are sometimes imprecise. Total occlusion of the internal carotid artery has often implied irreversibility. Carotid thromboendarterectomy was performed on eight patients who on angiography had a complete occlusion of proximal internal carotid artery but showed antegrade opacification of the infraophthalmic carotid siphon. Direct magnification, delayed radiography, and subtraction were used on all patients. In five of eight patients, normal antegrade cervical internal carotid blood flow was restored. The possible restoration of the occluded internal carotid artery lumen offers a viable alternative to bypass surgery in selected cases.