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Collateralization of an occluded internal carotid artery via a vas vasorum
V Kemény1, D W Droste, D G Nabavi
1Department of Neurology, University of Münster, Germany. kemeny@uni-muenster.de
Insights
Rare reopening of occluded internal carotid artery (ICA) occurred in a patient due to collateral circulation via vasa vasorum. This finding can mislead ultrasound diagnoses of carotid artery disease.
Area of Science:
- Vascular Surgery
- Neurology
- Diagnostic Imaging
Background:
- Internal carotid artery (ICA) occlusion reopening is common in dissections but rare in atherothrombotic disease.
- Atherothrombotic internal carotid artery (ICA) occlusion typically results in persistent blockage.
Observation:
- A 60-year-old man with stroke and dysphasia presented with left ICA occlusion on duplex ultrasonography.
- After 18 months of aspirin treatment, duplex ultrasonography showed a reopened left ICA with residual stenosis.
- Intra-arterial digital subtraction angiography revealed persistent ICA occlusion with collateral flow from vasa vasorum.
Findings:
- The case demonstrates rare collateralization of an occluded ICA by vasa vasorum.
- This collateral pathway developed over several months, mimicking recanalization on ultrasound.
- Vasa vasorum originated from the carotid bulb and drained distal to the occlusion.
Implications:
- This rare collateralization via vasa vasorum can be a diagnostic pitfall in ultrasound assessments of carotid artery occlusive disease.
- Accurate diagnosis requires correlating ultrasound findings with other imaging modalities like angiography.
- Understanding rare collateral pathways is crucial for managing cerebrovascular disease.
Background:
Reopening of an occluded internal carotid artery (ICA) is often seen in dissections but only rarely occurs in atherothrombotic occlusion of the internal carotid artery.
Case Description:
A 60-year-old man suffered a minor stroke with dysphasia in March 1995. Color-coded duplex ultrasonography of his neck arteries revealed a left ICA occlusion. He was placed on a regimen of aspirin and followed up clinically and with ultrasonography. At follow-up 18 months later, the patient was asymptomatic. On duplex ultrasonography his left occluded ICA was found to be reopened, with a residual, proximal, high-grade stenosis. However, intra-arterial digital subtraction angiography demonstrated a persistent ICA occlusion and a vas vasorum originating from the carotid bulb and draining into the ICA distal to the occlusion.
Conclusions:
The rare collateralization of an occluded ICA by vasa vasorum seems to take several months. It can be a pitfall in the ultrasound diagnosis of carotid artery occlusive disease.