ABSTRACT
Patients with complete carotid occlusion and recent ischemic symptoms are at high
risk for subsequent stroke, particularly those with evidence of severe hemodynamic
impairment due to poor collateral flow. Treatment options for these patients include
direct extracranial to intracranial arterial bypass, or interventions aimed at improving
collateral sources of flow such as endarterectomy or angioplasty and stenting of the
ipsilateral external carotid artery, the contralateral carotid artery, or the vertebral
arteries. The evidence supporting the use of these procedures for patients with complete
occlusion of the carotid artery will be the focus of this article. The use of physiologic
imaging to select subgroups of patients at high risk due to hemodynamic factors will
also be discussed.
KEYWORDS
Atherosclerosis - carotid artery - bypass - hemodynamic impairment
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Colin P DerdeynM.D.
Mallinckrodt Institute of Radiology and Departments of Neurology, and Neurological
Surgery, Washington University School of Medicine
510 South Kingshighway Blvd., St. Louis, MO 63110
Email: derdeync@wustl.edu
