Chronic common carotid occlusion.

Twelve patients with chronic common carotid artery (CCA) occlusion were studied. There were 8 patients with TIAs (3 hemispheric and 5 vertebral-basilar), one with a completed stroke, and 3 were asymptomatic. The ipsilateral internal carotid artery (ICA) was confirmed patent in 6 patients at the time of operation, although angiograms had demonstrated patency in only two. The ipsilateral external carotid artery (ECA) was patent in all but one patient. Arterial reconstructions were done on 7 patients. The carotid bifurcation was revascularized by subclavian-to-carotid bypass grafts in 5 patients, 3 with vertebral-basilar (V-B) TIAs, one with hemispheric TIAs, and one with a completed stroke. Vertebral revascularization was done on 2 patients, one with V-B TIAs and one who was asymptomatic. All revascularized patients had satisfactory results. Symptomatic patients can be treated by cerebral revascularization through either the ICA, if patent, the ECA via the ophthalmic collaterals, or through the vertebrals when hypoperfused. The ICA is preferentially revascularized and exploration often reveals a patent ICA that was not visualized angiographically. Recently, directional Doppler studies have proved useful in determining ICA patency.