Distinguishing Critical Stenosis from Occlusion of the Internal Carotid Artery by Carotid Duplex in a Patient with Acute Ischemic Stroke

Abstract

Accurate distinction of internal carotid artery (ICA) severe stenosis from occlusion in patients with acute stroke is crucial because carotid revascularization may reduce the risk of recurrent stroke. We report a 68-year-old man who had acute onset of right hemiparesis and hemiparesthesia. Head magnetic resonance imaging (MRI) on the first day and computed tomography (CT) angiography the next day showed total occlusion or pseudo-occlusion of the left ICA. However, carotid ultrasonography at around the same time clearly demonstrated focal severe stenosis of the left ICA orifice and catheter carotid angiography later confirmed the findings. The patient received angioplasty and stenting of the left ICA 3 weeks after stroke, and his follow-up course was uneventful. The case report highlights the value of carotid ultrasonography in distinguishing critical stenosis from occlusion of the carotid artery in patients with acute ischemic stroke.