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Common carotid occlusion. Assessment of the distal vessels
Abstract:
In patients with common carotid artery (CCA) occlusion, successful vascular reconstruction can be performed if there is a patent internal or external carotid distal to the occlusion. Preoperative selection of suitable candidates is often difficult because of the inability to visualize patent distal vessels with conventional angiography. In reviewing 24 patients operated upon for CCA occlusion since 1962, the distal internal or external carotid arteries were visualized in only four (17%) of the preoperative angiograms. When these 24 patients were explored, the internal carotid was found to be patent in 11 (46%) patients and the external patent in 15 (62%) cases. Of the 15 patients reconstructed, thromboendarterectomy was performed in six and saphenous vein bypass in nine. In the remaining nine patients, exploration revealed both the internal and external carotids to be thrombosed and unsuitable for CCA reconstruction. Recently we have used rapid sequential computerized tomography (RSCT) scanning to aid in the evaluation of the nonvisualized internal carotid artery (ICA). In two patients with CCA occlusion, RSCT correctly diagnosed patency of the ICA although it appeared to be occluded on angiography. Preliminary data suggest that RSCT will permit accurate preoperative selection of those CCA occlusion patients who are suitable surgical candidates and eliminate the need for surgical exploration.
Insights
Common carotid artery (CCA) occlusion diagnosis is challenging. Rapid sequential computerized tomography (RSCT) scanning shows promise in identifying suitable surgical candidates for CCA reconstruction, improving patient selection.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
- Neurology
Background:
- Common carotid artery (CCA) occlusion presents challenges for surgical reconstruction due to difficulties in visualizing distal patent vessels preoperatively.
- Conventional angiography has limited success (17%) in demonstrating patent internal or external carotid arteries distal to CCA occlusion.
- Surgical exploration reveals a significant number of patients with patent distal vessels (ICA in 46%, ECA in 62%) not identified by angiography.
Purpose of the Study:
- To evaluate the utility of rapid sequential computerized tomography (RSCT) scanning in assessing the patency of distal internal carotid arteries (ICA) in patients with CCA occlusion.
- To determine if RSCT can improve preoperative selection of surgical candidates for CCA reconstruction.
- To reduce the need for exploratory surgery in managing CCA occlusion.
Main Methods:
- Retrospective review of 24 patients operated for CCA occlusion since 1962.
- Analysis of preoperative conventional angiogram findings versus surgical exploration results.
- Application of rapid sequential computerized tomography (RSCT) scanning in two recent cases with non-visualized ICA on angiography.
Main Results:
- Conventional angiography visualized distal patent vessels in only 17% of CCA occlusion patients.
- Surgical exploration found the internal carotid artery (ICA) patent in 46% and external carotid artery (ECA) in 62% of cases.
- RSCT scanning accurately identified ICA patency in two patients where angiography suggested occlusion, potentially altering surgical candidacy.
Conclusions:
- Conventional angiography is insufficient for accurate preoperative assessment of distal carotid patency in CCA occlusion.
- Rapid sequential computerized tomography (RSCT) scanning demonstrates potential for reliable preoperative evaluation of the internal carotid artery (ICA) in CCA occlusion.
- RSCT may significantly improve patient selection for common carotid artery (CCA) reconstruction, potentially avoiding unnecessary surgical exploration.