Spontaneous Recanalization of an Occlusion of the Internal Carotid Artery

Abstract

As has been repeatedly described in the literature, vascular diseases of the extracranial arteries are dynamic processes and not static events. Since angiography is a diagnostic procedure involving a certain amount of risk and since any pathologic findings are almost always treated by surgery, follow-up angiographic examinations are rare. As early as 1959 Luessenhop (5) reported that occlusions of the internal carotid artery are found more frequently on angiograms made directly after an attack than on late angiograms. The recanalizations observed most frequently by angiography are those of the middle cerebral artery. The few available follow-ups tend to indicate that embolization of thrombotic material, and subsequently deterioration of neurologic status, is an indicator of recanalization. The new neurologic symptoms are produced by the embolization of thrombotic material during recanalization. Most cases of “reversible angiopathy” can be attributed to spontaneous dissection, vasculitis, or “idiopathic regressive angiopathy” (1). In the cervical vessels, this phenomenon is most frequently associated with dissecting aneurysms; it is not, however, a true recanalization. In particular, these observations have been described in stenoses of the distal carotid artery, where direct surgery and, therefore, histologic evaluation, was impossible.