Bilateral Internal Carotid Artery Occlusion Research Articles

Surgical management of the patient with bilateral internal carotid artery occlusion

The patient with bilateral internal carotid artery occlusion is at high risk for development of stroke. Medical management and extracranial-intracranial bypass do not appear to offer these patients any protection from symptoms of cerebrovascular insufficiency. Our initial treatment in 11 of 12 patients who had this pattern of extracranial arterial occlusion has been external carotid artery revascularization. Nineteen procedures were performed for symptomatic lesions in all cases except one. There were no perioperative strokes or deaths. During a mean follow-up of 44.7 months, no new strokes occurred. Among 10 patients undergoing external carotid artery revascularization alone, only one transient ischemic attack occurred in follow-up. Seven of the eight surviving patients are presently asymptomatic. External carotid artery revascularization may be an effective and durable treatment for the patient with bilateral internal carotid artery oclusion.

Optico-cerebral syndrome: simultaneous hemodynamic infarction of optic nerve and brain.

Three (0.5%) of 612 patients with an acute ischemic stroke in the carotid territory also had ipsilateral optic nerve infarction. They had unilateral or bilateral internal carotid artery occlusion and reversed flow in the ophthalmic artery. Hemodynamic infarction was suggested by triggering by a drop in blood pressure, decreased ophthalmic artery flow and perfusion pressure, and cerebral infarction in a watershed area. The "optico-cerebral syndrome" suggests internal carotid artery occlusion with hemodynamic disturbances. In carotid disease, monocular blindness may be due to an optic nerve lesion sparing the retina.

Reactivity of the cerebral circulation in patients with carotid occlusion.

Cerebral blood flow (CBF) and the response to hypercapnia (cerebral reactivity) have been measured in 41 patients with unilateral or bilateral internal carotid artery occlusion in an attempt to identify those with limited collateral reserve. Normocapnic CBF was within normal limits in the majority of subjects. The response to hypercapnia varied from normal to absent, with impaired reactivity becoming increasingly likely when more than one artery was diseased. In 19 patients with unilateral carotid occlusion, hemisphere reactivity was well preserved in the majority, but was significantly lower on the side of the occlusion (mean 2.9%/mm Hg) compared to the normal side (mean 3.4%/mm Hg). Reactivity on the side of the occlusion was further reduced in 15 patients with occlusion and contralateral internal carotid artery stenosis (mean 1.7%/mm Hg) and was even lower in seven patients with bilateral occlusion (mean 1.1%/mm Hg). There was no difference in reactivity between asymptomatic hemispheres in the 41 patients (mean 2.7%/mm Hg) and hemispheres in which a previous stroke had occurred (mean 2.8%/mm Hg). In contrast the response in hemispheres subject to continuing transient ischaemic attacks was significantly impaired (mean 1.6%/mm Hg), suggesting that the cerebral symptoms in some of these patients may have had a haemodynamic origin more often than suspected from the clinical history.

Results of extracranial-intracranial arterial bypass for bilateral carotid occlusion.

The results of superficial temporal to middle cerebral artery bypass surgery for bilateral internal carotid artery occlusion were reviewed in 39 patients. Preoperative symptoms included recurrent transient ischemic attacks (TIA's) in 31 patients (80%) and mild or moderate stroke in 15 (29%). Deficits were unilateral in 23 cases and bilateral in 14. Dementia or personality changes were observed in 19 patients (49%). Operative morbidity occurred in six of 39 cases and was neurological in one; the surgical mortality rate was 8% (three of 39 patients), including two cases of cerebral hemorrhage. The outcome was good or excellent (relief of TIA's and reduction of neurological deficit) in 82% of patients over a follow-up period of 3 to 139 months. Five patients had a late postoperative stroke, which occurred in the unoperated hemisphere in each case; one patient had an ipsilateral TIA 6 years after the bypass procedure. These results suggest that an extracranial-intracranial arterial bypass procedure to augment collateral cerebral blood flow can be performed safely in patients with bilateral internal carotid artery occlusion and may be associated with relief of ischemic symptoms. Future studies may document a role for this procedure in the prevention of stroke.

Pituitary apoplexy associated with a triple bolus test

The authors report a case of pituitary apoplexy resulting in bilateral internal carotid artery occlusion, with marked depression of consciousness and hemiplegia. After transsphenoidal tumor decompression, restoration of flow in both carotid arteries was documented angiographically and the patient made an excellent clinical recovery. The unique aspect of this case is that the pituitary apoplexy was apparently precipitated by neuroendocrine manipulation, performed as a preoperative test of pituitary function.

Bilateral internal carotid artery occlusion. Its surgical management.

Seven patients with symptomatic bilateral internal carotid artery occlusion had 11 extracranial operations involving carotid, vertebral, and subclavian arteries. A priority approach to the extracranial vessels was followed. Priority was given to the correction of subclavian steal when present. An external carotid angioplasty or bypass was given priority if its origin was stenotic or occluded. If both vertebral arteries, or the dominant one, had stenoses at their origin greater than 75% of the cross-sectional area, a subclavian-vertebral artery bypass was performed. When both internal carotid arteries are occluded, the external carotid and vertebrovasilar systems are the main collaterals and are often also stenotic. Correction of these occlusive lesions in the collateral pathways produced complete symptomatic relief in these patients. In two selected cases with specific angiographic findings and a normal blood pressure, immediate internal carotid thromboendarterectomy was performed. No morbidity or mortality was encountered in these seven patients.

Mucocele of the sphenoid sinus with bilateral internal carotid artery occlusion. Case report.

✓ A young man with a large sphenoid sinus mucocele developed hypopituitarism, headaches, and visual difficulties. Subsequently the lesion caused complete occlusion of both internal carotid arteries in the parasellar region. The headaches and visual difficulty improved after simple transoral drainage of the cyst.

BILATERAL INTERNAL CAROTID ARTERY OCCLUSION SECONDARY TO CLOSED HEAD INJURIES.

Complications ofbasilar skullfracture, suchas carotid cavernous fistulae, meningitis, cerebrospinal fluid rhinorrhoea andotorrhoea, pneumatocele, andvarious cranial nervedisturbances, are wellknown(Gurdjian andWebster, 1958). In -addition, unilateral thrombosis oftheinternal carotid artery, bothwithandwithout basilar skull fracture, hasfrequently beenreported after closed headand neckinjury (Ecker, 1945; Higazi, 1963, Hockaday, 1959; Murray, 1957; Northcroft andMorgan, 1944; Schneider andLemmen,1952). Bilateral occlusion oftheinternal carotid arteries asacauseofdeath secondary tobasilar skull fracture hasapparently notbeenreported. Thispresentation demonstrates pre-andpost-mortem documentation ofacaseof bilateral internal carotid occlusion inthecarotid siphon secondary tofracture ofthecranial base. CASE PRESENTATION

ACUTE BILATERAL INTERNAL CAROTID ARTERY OCCLUSION; REPORT OF A CASE FOLLOWING A PARACHUTE JUMP.

ACUTE BILATERAL INTERNAL CAROTID ARTERY OCCLUSION; REPORT OF A CASE FOLLOWING A PARACHUTE JUMP.