Bilateral internal carotid artery occlusion. Its surgical management
R. Berguer, J. F. McCaffrey and R. B. Bauer
Seven patients with symptomatic bilateral internal carotid artery occlusion
had 11 extracranial operations involving carotid, vertebral, and subclavian
arteries. A priority approach to the extracranial vessels was followed.
Priority was given to the correction of subclavian steal when present. An
external carotid angioplasty or bypass was given priority if its origin was
stenotic or occluded. If both vertebral arteries, or the dominant one, had
stenoses at their origin greater than 75% of the cross-sectional area, a
subclavian-vertebral artery bypass was performed. When both internal
carotid arteries are occluded, the external carotid and vertebrovasilar
systems are the main collaterals and are often also stenotic. Correction of
these occlusive lesions in the collateral pathways produced complete
symptomatic relief in these patients. In two selected cases with specific
angiographic findings and a normal blood pressure, immediate internal
carotid thromboendarterectomy was performed. No morbidity or mortality was
encountered in these seven patients.
