2021 Volume 49 Issue 6 Pages 458-462
Symptomatic common carotid artery occlusion (CCAO) is relatively rare. This case study reports on a 68-year-old woman who presented with moderate aphasia and right hemiparesis and underwent carotid endarterectomy (CEA) for managing CCAO. Magnetic resonance imaging (MRI) showed multiple infarctions in the watershed area of the left subcortical white matter. Angiography demonstrated left CCAO with preservation of the internal carotid artery (ICA) and collateral filling of the external carotid artery (ECA) from the superior thyroid artery via the inferior thyroid artery. Because the occluded segment of the left common carotid artery (CCA) was short, CEA was performed for managing CCAO. The procedure was performed 7 weeks after the onset. Postoperative MRI revealed no new ischemic lesions. Direct CEA for treating short-segment CCAO with preservation of the ICA can be safely performed using the following three key steps: 1) adequate exposure of the proximal CCA, 2) appropriate removal of the thrombus in the occluded CCA, and 3) appropriate order of releasing the clamp in consideration of the collateral circulation.
