Abstract
Clinical manifestation of carotid occlusive disease is largely dependent on the severity
of stenosis and the capability of collateral circulation. However, due to the complexity
and difficulty in evaluation, cerebral collateral circulation has, so far, remained
underappreciated. We report a patient with advanced extracranial arterial disease
(including the right subclavian steal, occlusion of the right external carotid artery,
and severe stenosis of the left vertebral artery), who underwent transient right internal
carotid artery occlusion during carotid intervention. Throughout the occlusion, the
flow into the right hemisphere (monitored by transcranial Doppler ultrasound in the
right middle cerebral artery) was sufficient despite almost totally dependent on the
anterior communicating artery, which highlights its role as the most potent collateral
pathway.
Keywords
carotid occlusion - transcranial Doppler - cerebrovascular reserve - collateral circulation
