Two Symptomatic Cases of Common Carotid Artery Occlusion

Abstract

Common carotid artery (CCA) occlusion is a rare form of ischemic cerebrovascular disease. The authors report two symptomatic cases of CCA occlusion, describing one patient in the acute phase and another in the chronic phase. The first patient, a 63-year-old female with a two-month history of right side visual disturbance came to our hospital for investigation. MRI demonstrated multiple cerebral infarctions in the right subcortical white matter. Angiography confirmed nearly occlusion of the right CCA at its bifurcation and filling of the external carotid artery (ECA) via collaterals from the occipital artery. Single photon emission computed tomography showed hemodynamic cerebral ischemia in the affected cerebral hemisphere. Seventy-three days after the first examination, the patient performed CCA to the middle cerebral artery (MCA) radial artery bypass without new neurological complications. The patient recovered normal vision of right eye after surgery. The second patient, a 42-year-old female was admitted to our hospital with motor-dominant aphasia and mild right hemiparesis. MRI did not demonstrate lesions causing these neurological deficits. Angiography confirmed occlusion of the left CCA at its origin, which had been normal three years before onset, and filling of ECA and internal carotid artery from an occipitovertebral anastomosis. The patient was not indicated for revascularization therapy in the acute period and medical therapy was administered. However, her symptoms gradually progressed and infarction extended almost to the MCA territory. Surgical treatment for chronic CCA occlusion is a prophylactic method for cerebral infarction and the procedures are decided based on the occluded position of CCA and patent arteries. However, it is difficult to perform surgery in acute CCA occlusion because of the limited therapeutic window and invasiveness of surgery.