Abstract
BackgroundCommon carotid artery (CCA) occlusion (CCAO) is a rare condition. Owing to collateral circulation, ipsilateral internal carotid artery (ICA) and external carotid artery (ECA) are often patent.MethodsThis study included 16 patients with unilateral CCAO and patent ipsilateral ICA and ECA. The pathways which supplied ICA were investigated by digital subtraction angiography (DSA), transcranial Doppler (TCD), magnetic resonance angiography (MRA) and computed tomography angiography (CTA).ResultsIn all 16 patients, TCD found antegrade blood flow in ipsilateral ICA, which was supplied by retrograde blood flow in ipsilateral ECA through carotid bifurcation. We call this phenomenon “ICA steal”. DSA and CTA discovered four pathways of ICA steal, including 1) ipsilateral vertebral artery – occipital artery – ECA – ICA, 2) ipsilateral thyrocervical trunk or costocervical trunk – ascending cervical artery or deep cervical artery – occipital artery – ECA – ICA, 3) contralateral ECA – contralateral superior thyroid artery – ipsilateral superior thyroid artery – ipsilateral ECA – ICA, and 4) ipsilateral thyrocervical trunk – inferior thyroid artery – superior thyroid artery – ECA – ICA.ConclusionsICA is possible to be patent and supplied by several collateral circulation pathways after CCAO.
Highlights
Common carotid artery (CCA) occlusion (CCAO) is a rare condition
From the database we found 16 patients with unilateral Common carotid artery occlusion (CCAO) but patent ipsilateral internal carotid artery (ICA) and external carotid artery (ECA) (Riles type 1A)
transcranial Doppler (TCD) No blood flow was detected in the occluded CCA (Fig. 1a), while the healthy CCA had normal blood flow (Fig. 1b)
Summary
Common carotid artery (CCA) occlusion (CCAO) is a rare condition. Ipsilateral internal carotid artery (ICA) and external carotid artery (ECA) are often patent. One of the risks of ischemic stroke is pathological changes of extracranial carotid circulation. Atherosclerotic occlusion of internal carotid artery (ICA) has been intensively studied for its clinical and imaging characteristics. Common carotid artery (CCA) occlusion (CCAO) is rarely studied due to its low incidence [1, 2]. Consensus has not been reached as for the indications, necessities and clinical benefits of invasive treatment of CCAO. According to Riles et al’s classification, CCAO has four types: type 1A with patent ICA and external carotid artery (ECA), type 1B with occluded ICA and patent ECA, type 1C with patent ICA and occluded ECA, and type 2
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