The totally occluded internal carotid artery. Preliminary observations using rapid sequential computerized tomographic scanning
T. S. Riles, M. P. Posner, W. S. Cohen, R. Pinto, A. M. Imparato and F. G. Baumann
Cerebral angiography often cannot distinguish between complete thrombosis
or fibrosis of the internal carotid artery (ICA) and nonvisualization due
to a total occlusion of the common carotid or origin of the ICA. Whereas
surgery may be beneficial if the distal carotid is patent (type 1),
thromboendarterectomy may be contraindicated if thrombus or fibrosis extend
to the intracranial branches (type 2). Rapid sequential computerized
tomography (RSCT) was used to examine 15 patients whose ICAs appeared
occluded by angiography. Of four ICAs classed as type 1 by RSCT, three were
found to be patent during surgical exploration, and carotid reconstruction
was successfully performed. Three other ICAs classed as type 2 by RSCT were
also surgically explored, and complete thrombosis was confirmed. The RSCT
technique provides an effective and nonoperative means of determining
whether a nonvisualized ICA is reconstructible.
