Published online Jan 16, 2018. doi: 10.12998/wjcc.v6.i1.6
Peer-review started: November 17, 2017
First decision: November 30, 2017
Revised: December 6, 2017
Accepted: December 14, 2017
Article in press: December 15, 2017
Published online: January 16, 2018
Occlusion of the common carotid artery (CCA) is rare. CCA occlusion (CCAO) can present as drowsiness and right hemiplegia related to emboli after total arch replacement. Although we selected a follow-up at first because color duplex sonography showed retrograde flow from the left external carotid artery to the internal carotid artery, this patient had epilepsy and single-photon emission computed tomography (SPECT) acquired quantitative results of actual brain perfusion and showed insufficient collateral blood flow. To improve brain perfusion, we performed a bypass of the left subclavian artery to left CCA bypass. Postoperatively, the patient did not have epilepsy and drowsiness. Also, right hemiplegia improved enough for him to walk with support. SPECT showed increased left cerebral flow (the asymmetry ratio was 71% to 81%). Evaluation of the carotid artery with color duplex sonography alone was insufficient when CCAO showed retrograde or collateral flow. We should have performed quantitative evaluation with SPECT at the same time.
Core tip: Common carotid artery occlusion (CCAO) can include neurologic symptoms caused by low cerebral perfusion; however, blood flow in the internal carotid artery and external carotid artery is maintained by collateral circulation in most cases. In the former, we can noninvasively estimate the presence and intensity of collateral flow by single-photon emission computed tomography. In the latter, color flow duplex examination detects the patency of the distal vessels. Patients with CCAO should undergo estimation of the patency of their distal CCA and cerebral perfusion at the same time. Surgical management requires safe and effective strategies for symptomatic CCAO.