Korean Circ J.  2010 Jun;40(6):288-291. 10.4070/kcj.2010.40.6.288.

Successful Carotid Stenting for Chronic Total Occlusion of the Internal Carotid Artery

• Kim WH
• Min PK
• Kim DJ
• Shim WH

• KMID: 2225190
• DOI: http://doi.org/10.4070/kcj.2010.40.6.288

Abstract

A 64-year-old man complaining of pulsatile headache was admitted. Imaging studies revealed a near-total occlusion of the right proximal internal carotid artery (ICA) with slow antegrade flow into the distal ICA. Right cerebral flow was supplied by collateral flow through the posterior communicating and ophthalmic arteries. He was successfully treated by carotid artery stenting. No new neurological deficit or transient ischemic attack occurred after treatment.

Keyword

Thrombosis, internal carotid artery; Stents

MeSH Terms

Carotid Arteries
Carotid Artery Thrombosis
Carotid Artery, Internal
Headache
Humans
Ischemic Attack, Transient
Middle Aged
Ophthalmic Artery
Stents

Figure

• 

  Fig. 1 A: cerebral angiography from the right CCA confirms the presence of a near-total occlusion of the right proximal ICA with slow antegrade flow into the distal ICA (arrow). B: right cerebral flow is supplied by collateral flow through the posterior communicating (arrow) and ophthalmic arteries (arrow), as shown on an angiogram of the extracranial artery. CCA: common carotid artery, ICA: internal carotid artery.

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  Fig. 2 A: single-photon emission CT scanning with a 99mTc-ethyl cysteinate dimmer revealed decreased uptake in the right cerebral hemisphere. B: scans obtained after the Diamox challenge showed no increase in cerebral flow in the right cerebral hemisphere, suggestive of a decrease in vascular reserve.

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  Fig. 3 Endovascular treatment. A: proximal ICA occlusion. B: the wire advancing with the microcatheter. C: predilatation with a coronary balloon. D: successful stenting insertion. E: final angiogram after carotid stent implantation after adjuvant balloon post-dilation.

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  Fig. 4 Single-photon emission CT scanning with a 99mTc-ethyl cysteinate dimmer obtained after endovascular recanalization. A: cerebral blood flow at rest increased in the right frontotemporal region compared to that before treatment. B: vascular reactivity for the Diamox challenge also recovered.

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  Fig. 5 Post-procedural magnetic resonance angiography revealed complete recanalization of the right ICA with normal antegrade flow distal to the previously occluded segment (B) compared to pre-procedural magnetic resonance angiography (A).

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