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(Stroke. 1998;29:521-523.)
© 1998 American Heart Association, Inc.

Case Report

Collateralization of an Occluded Internal Carotid Artery Via a Vas Vasorum

Vendel Kemény, MD; Dirk W. Droste, MD; Darius G. Nabavi, MD; Gernot Schulte-Altedorneburg, MD; Gerhard Schuierer, MD; E. Bernd Ringelstein, MD

From the Department of Neurology (V.K., D.W.D., D.G.N., G.S.-A., E.B.R.) and the Institute of Clinical Radiology (G.S.), University of Münster (Germany).

Correspondence to Vendel Kemény, MD, Department of Neurology, University of Münster, Albert-Schweitzer-Str 33, D-48129 Münster, Germany. E-mail kemeny{at}uni-muenster.de

Background—Reopening of an occluded internal carotid artery (ICA) is often seen in dissections but only rarely occurs in atherothrombotic occlusion of the internal carotid artery.

Case Description—A 60-year-old man suffered a minor stroke with dysphasia in March 1995. Color-coded duplex ultrasonography of his neck arteries revealed a left ICA occlusion. He was placed on a regimen of aspirin and followed up clinically and with ultrasonography. At follow-up 18 months later, the patient was asymptomatic. On duplex ultrasonography his left occluded ICA was found to be reopened, with a residual, proximal, high-grade stenosis. However, intra-arterial digital subtraction angiography demonstrated a persistent ICA occlusion and a vas vasorum originating from the carotid bulb and draining into the ICA distal to the occlusion.

Conclusions—The rare collateralization of an occluded ICA by vasa vasorum seems to take several months. It can be a pitfall in the ultrasound diagnosis of carotid artery occlusive disease.

Key Words: carotid arteries • occlusion • ultrasonography • angiography

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