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Stroke, Vol 15, 149-157, Copyright © 1984 by American Heart Association

ARTICLES

Patency of external and internal carotid artery in the presence of an occluded common carotid artery: noninvasive evaluation with combined cerebrovascular Doppler examination and sequential computertomography

HM Keller, A Valavanis, HG Imhof and M Turina

The patency of the external carotid artery (ECA) and internal carotid artery (ICA) in the presence of an occlusion of the common carotid artery (CCA) was evaluated in 7 patients with a symptomatic CCA occlusion by the combined application of cerebrovascular Doppler examination (cv-Doppler) based on continuous-wave equipment and sequential computertomographic scans with intravenous bolus injection of contrast material (sequential CT-scans). Occlusion of the CCA was demonstrated by cv- Doppler and sequential CT-scans and confirmed by routine angiography. A patent ECA was found in all 7 patients by the combined method, but could not be demonstrated by routine angiography in one of these patients. A patent ICA was found in 2 patients by the combined method, while routine angiographic findings concerning the patency of the ICA were equivocal. An occluded ICA was found in 5 patients by the cv-Doppler-sequential CT-scans method, where routine angiographic findings also were equivocal. Operation to restore blood flow in the CCA was performed in 5 patients and successful in 3 patients in whom blood flow from the CCA to the ECA could be achieved in 2 patients, and to the ECA and ICA in one patient, as predicted by the combined cv-Doppler-sequential CT-scans method. Thus, the patency of the ICA in the presence of a CCA occlusion can be reliably evaluated by the combined diagnostic procedure. The method may help to decide for further diagnostic work-up, e.g., specific selective injections and projections in more than two plans during cerebral angiography, and/or successful surgical intervention in a given patient with a CCA occlusion, even if angiographic findings are equivocal.

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