Abstract
A 58-year-old woman complained of transient left hemiparesis. MR angiograms on admission revealed obscuration of the right internal carotid and middle cerebral artery, although MR images did not show any new ischemic lesion. Cerebral angiography (CAG) showed abrupt occlusion of the right common carotid artery (CCA) just after the superior thyroid artery branching. CAG also revealed a severe stenosis of the left CCA. The right carotid bifurcation was patent because the occluded segment of the right CCA was very short. Retrograde filling of the right occipital artery from the muscular branches of right vertebral artery produced the collateral blood supply to the right ICA through the patent carotid bifurcation. Although an orthograde flow of the right ICA was observed, single-photon emission computed tomography indicated reduced blood flow at rest, and severely impaired cerebral vascular reactivity in the right cerebral hemisphere. It was, therefore, proper to revascularize the occluded right carotid artery. We thought that carotid endoarterectomy (CEA) was suitable to ensure an enough blood flow safely in this patient. She was also diagnosed as aortitis syndrome clinically. We needed a corticosteroids therapy before the surgery. After the normalization of results of biochemical tests indicating inflammatory response, CEA for the occluded right CCA was performed successfully. The patient was able to walk independently and was discharged from our hospital 14 days after surgery. There were two major reasons to choose and perform a CEA successfully in this case. One reason was a short segmental occlusion, and the other was a reserved antegrade flow from the origin of ICA. We report this case with a review of literatures.
