Carotid Endarterectomy for Pseudo-occlusion of the Internal Carotid Artery : Surgical Indication and Usefulness of Doppler during Operative Procedure

Abstract

We report a case treated successfully by CEA for pseudo-occlusion of the ICA. A 77-year-old man was admitted with brain infarction. Carotid angiography showed a nearly occluded right ICA at the origin. The intracranial portion of the early arterial phase showed back-filling of the carotid siphon via the ophthalmic artery. The late arterial phase of the same right common carotid angiography revealed extremely delayed antegrade flow through the patent ICA. Conventional carotid ultrasonography and transoral carotid ultrasonography enabled us to decide that CEA was indicated. Intraoperative doppler showed the patent of the distal ICA. Flow patterns of the ICA and the ECA after CEA were normalized. Doppler is a very useful tool to evaluate the dynamic change of the flow pattern during the operative procedure.