Abstract
A 79 year old female with headache, syncope, mild aphasia, and dysarthria was diagnosed with a left common carotid artery occlusion. Computed tomography angiography showed a necklace (A, white arrow) of extracranial communications between external carotid arteries through the superior thyroid arteries. This symptomatic patient underwent a hybrid procedure including distal common carotid endarterectomy, retrograde recanalisation of the occlusion, and covered stent implantation (7 x 50 mm and 8 x 100 mm Viabahn, W.L. Gore Associates, Inc, Flagstaff, AZ, USA). The post-operative course was uneventful, with symptom relief and patency of the common and internal carotid arteries (B).Image 1
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