Related Experiment Video
Updated: Aug 11, 2026
Bilateral Common Carotid Artery Occlusion as an Adequate Preconditioning Stimulus to Induce Early Ischemic Tolerance to Focal Cerebral Ischemia
Published on: May 9, 2013
Subclavian-carotid bypass to an "isolated" carotid bifurcation: a retrospective analysis
1Department of Vascular Surgery, Cleveland Clinic Foundation, OH 44195, USA.
Insights
Patients with common carotid artery occlusion but patent bifurcations face stroke risks. Surgical bypass offers a safe and effective treatment with good long-term outcomes for these rare cases.
Area of Science:
- Vascular Surgery
- Neurology
- Diagnostic Imaging
Background:
- Occlusion of the common carotid artery (CCA) often involves the internal and external carotid arteries.
- A subset of patients maintain internal carotid artery (ICA) flow via retrograde external carotid artery (ECA) supply, posing risks for stroke and transient ischemic attacks (TIAs).
- Traditional diagnosis relied on arteriography or blind exploration, which are invasive or suboptimal.
Purpose of the Study:
- To evaluate the diagnostic utility of color-enhanced duplex ultrasonography (DUS) for identifying CCA occlusion with a patent carotid bifurcation.
- To assess the surgical management and long-term outcomes of patients with this specific cerebrovascular condition.
Main Methods:
- Retrospective review of nine patients diagnosed with CCA occlusion and patent bifurcation via DUS between 1985 and 1994.
- Confirmation of diagnosis with cerebral arteriography.
- Surgical treatment involving subclavian-carotid bypass with or without bifurcation endarterectomy.
Main Results:
- DUS successfully identified nine patients with CCA occlusion and patent bifurcations presenting with TIAs, stroke, or vertebrobasilar insufficiency.
- All patients underwent successful surgical repair (subclavian-carotid bypass, with endarterectomy in five cases) without perioperative stroke, TIA, or death.
- Six of eight survivors remained asymptomatic at a mean follow-up of 37.1 months.
Conclusions:
- Color-enhanced DUS is a valuable tool for diagnosing CCA occlusion with a patent bifurcation, obviating the need for blind exploration.
- Surgical intervention, including subclavian-carotid bypass, is a safe and effective treatment for symptomatic patients, yielding favorable long-term results.
Abstract:
Most patients with occlusion of the common carotid artery will have concomitant occlusion of the internal and external carotid arteries. A few, however, will maintain antegrade internal carotid flow via retrograde flow from the ipsilateral external carotid artery. These patients remain at risk for hemispheric transient ischemic attacks (TIAs), ischemic stroke, or vertebrobasilar insufficiency/global cerebral ischemia. Historically, diagnosis of this condition has relied on cerebral arteriography and/or blind exploration of the carotid bifurcation. More recently, color-enhanced duplex ultrasonography has been used to facilitate the diagnosis and has allowed focused, delayed arteriographic views of the appropriate carotid bifurcation, making blind exploration unnecessary. From 1985 to 1994, nine patients with TIAs (n = 5), completed stroke with minimal residual deficit (n = 2), or vertebrobasilar insufficiency (n = 2) were found to have occlusion of the common carotid artery with a patent carotid bifurcation on duplex ultrasound images. All nine had this particular anatomic condition confirmed by arteriography and were subsequently treated by subclavian-carotid bypass using autologous reversed saphenous vein (n = 5) or synthetic (n = 4) grafts. Five of nine patients required concomitant bifurcation endarterectomy. There were no perioperative strokes or TIAs and no operative deaths. Six of eight survivors remain asymptomatic at 1 to 92 months' follow-up (mean 37.1 months). Symptomatic patients with occluded common carotid arteries and patent bifurcations can be treated surgically with low operative morbidity and good long-term results.
More Related Videos
07:04Creation of Two Saccular Elastase-Digested Aneurysms with Different Hemodynamics in One Rabbit
Published on: April 15, 2021
09:36A Magnetic Resonance Imaging-based Computational Protocol for Analysis of Plaque Morphology and Hemodynamics in Patients with Carotid Artery Stenosis
Published on: August 12, 2025