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Symptomatic haemodynamically significant carotid occlusion treated by posterior circulation revascularization
R P White1, P Barnes, H S Markus
1Department of Clinical Neuroscience, King's College School of Medicine and Dentistry and Institute of Psychiatry, London, UK. spgtrpw@iop.bpmf.ac.uk
Cerebrovascular Diseases (Basel, Switzerland)
|June 10, 1998
Summary
Revascularizing subclavian artery stenosis resolved vertebrobasilar steal and improved cerebral haemodynamic symptoms in a patient with internal carotid artery occlusion. Transcranial Doppler monitoring confirmed symptom resolution and improved carbon dioxide reactivity.
Area of Science:
- Neurology
- Vascular Surgery
- Neuroimaging
Background:
- Internal carotid artery (ICA) occlusion can cause haemodynamic cerebral ischaemic symptoms.
- Vertebrobasilar steal syndrome secondary to subclavian artery stenosis can exacerbate these symptoms.
- Assessing cerebral haemodynamic reserve is crucial for managing such cases.
Observation:
- A patient with symptomatic ICA occlusion and ipsilateral subclavian stenosis presented with transient ischaemic attacks and stroke.
- Duplex and angiography revealed vertebrobasilar steal with a patent posterior communicating artery.
- Transcranial Doppler showed significantly impaired middle cerebral artery carbon dioxide reactivity.
Findings:
- Percutaneous angioplasty of the subclavian artery stenosis successfully normalized vertebral artery flow and resolved the steal phenomenon.
- The patient's transient ischaemic attacks and stroke symptoms completely resolved post-procedure.
- Post-intervention, middle cerebral artery carbon dioxide reactivity improved to near normal limits.
Implications:
- Subclavian artery revascularization can effectively treat haemodynamic anterior circulation symptoms in specific ICA occlusion cases.
- Transcranial Doppler assessment of middle cerebral artery reactivity is a valuable tool for diagnosis and monitoring.
- This case highlights the importance of addressing proximal extracranial occlusive disease impacting cerebral haemodynamics.