Abstract
We report a case of a 67-year-old man with sudden onset of right hemiplagia and total aphasia. Left common carotid angiography showed complete occlusion of the cervical internal carotid artery (ICA) near the bifurcation and the ipsilateral middle cerebral artery (MCA) at the M1 segment. The occluded site of the cervical ICA was considered to be a short thrombus judging from the staining in the petrous ICA via the opthalmic artery. A guiding catheter was able to pass through the occluded site of the cervical ICA over a guide wire (0.035 inch, angle type) and intracranial angioplasty was performed through the guiding catheter, enabling an early restoration of the cerebral blood flow. The patient improved after the procedure. Severe narrowing of the cervical ICA remained, and carotid endarterectomy (CEA) was performed. He had no recurrence, and the revascularization of the cervical ICA and MCA at M 1 segment remained after 1.5 years of post-treatment. We recommend a combination of the endovascular and surgical approaches for occlusion of the cervical ICA and the ipsilateral intracranial main trunk.
