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Abstract
In the presence of chronic internal carotid artery occlusion, the external carotid
artery becomes an important source of collateral circulation to the ipsilateral cerebral
hemisphere and eye. It not only supplies blood via periorbital collaterals with retrograde
flow in the ophthalmic artery, but also may allow emboli to reach the retina or brain.
The cul-de-sac or “stump” created by internal carotid artery occlusion may frequently
be the source of emboli causing amaurosis fugax or hemispheric transient ischemic
episodes. Seven such patients presenting with amaurosis fugax and/or hemispheric transient
ischemic episodes were found at operation to have atherosclerotic ulceration or platelet
fibrin debris at the carotid bifurcation and the internal carotid artery cul-de-sac.
These patients were treated by external carotid endarterectomy with excision and closure
of the occluded internal carotid artery cul-de-sac to remove a potential source of
stasis and platelet fibrin deposition. A preoperative angiogram and intraoperation
photograph demonstrating the typical pathologic findings are presented. The surgical
technique emphasizing excision and closure of the internal carotid cul-de-sac is illustrated.
Six of the seven patients have remained asymptomatic with a 2- to 28-month follow-up.
The importance of considering microembolism as a cause of symptoms in some patients
without external carotid artery stenosis is stressed.
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Article info
Footnotes
☆Presented at the Fifth Annual Meeting of the Midwestern Vascular Surgical Society, Chicago, Ill., Sept. 25–26, 1981.
Identification
Copyright
© 1983 Published by Elsevier Inc.
