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Internal Carotid Artery Occlusion: Pathophysiology, Diagnosis, and Management

  • Cardiovascular Disease and Stroke (S. Prabhakaran, Section Editor)
  • Published:
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Abstract

Purpose of Review

Acute internal carotid artery occlusion (ICAO) is associated with large infarcts and poor clinical outcomes and contributes to morbidity and mortality worldwide. In this review, we discuss various etiologies and pathophysiology of clinical presentations of ICAO, different radiographic patterns, and management of patients with ICAO.

Recent Findings

Recanalization rates remain suboptimal with systemic thrombolysis amongst patients with acute ICAO. Recent success of endovascular therapy for vessel occlusion in anterior circulation has expanded the horizons; however, few patients with cervical dissections and ICAO were included in these landmark trials.

Summary

Acute ICAO responds poorly to intravenous thrombolysis and portends worse clinical outcomes. Extracranial and intracranial ICAOs have varied clinical course and imaging patterns, with discrete cervical ICAO usually associated with better clinical outcomes while tandem occlusions predispose poor outcomes. Diagnostic catheter-based angiogram is often required since appearances of ICAO using non-invasive neuroimaging modalities are often deceiving. Repeated vascular imaging in acute to subacute phase to determine recanalization of ICAO is critical for secondary prevention. Recent success of endovascular procedures will continue to expand the horizons to improve the management of ICAO.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Bhatia R, Hill MD, Shobha N, Menon B, Bal S, Kochar P, et al. Low rates of acute recanalization with intravenous recombinant tissue plasminogen activator in ischemic stroke: real-world experience and a call for action. Stroke. 2010;41(10):2254–8. https://doi.org/10.1161/strokeaha.110.592535.

    Article  CAS  PubMed  Google Scholar 

  2. Paciaroni M, Inzitari D, Agnelli G, Caso V, Balucani C, Grotta JC, et al. Intravenous thrombolysis or endovascular therapy for acute ischemic stroke associated with cervical internal carotid artery occlusion: the ICARO-3 study. J Neurol. 2015;262(2):459–68. https://doi.org/10.1007/s00415-014-7550-1.

    Article  CAS  PubMed  Google Scholar 

  3. Paciaroni M, Caso V, Venti M, Milia P, Kappelle LJ, Silvestrelli G, et al. Outcome in patients with stroke associated with internal carotid artery occlusion. Cerebrovasc Dis (Basel, Switzerland). 2005;20(2):108–13. https://doi.org/10.1159/000086800.

    Article  Google Scholar 

  4. Buslovich S, Hines GL. Spontaneous recanalization of chronic internal carotid artery occlusions: report of 3 cases. Vasc Endovasc Surg. 2011;45(1):93–7. https://doi.org/10.1177/1538574410380792.

    Article  Google Scholar 

  5. Faught WE, van Bemmelen PS, Mattos MA, Hodgson KJ, Barkmeier LD, Ramsey DE, et al. Presentation and natural history of internal carotid artery occlusion. J Vasc Surg. 1993;18(3):512–23. discussion 24

    Article  CAS  PubMed  Google Scholar 

  6. Powers WJ, Derdeyn CP, Fritsch SM, Carpenter DA, Yundt KD, Videen TO, et al. Benign prognosis of never-symptomatic carotid occlusion. Neurology. 2000;54(4):878–82.

    Article  CAS  PubMed  Google Scholar 

  7. Malhotra K, Liebeskind DS. Collaterals in ischemic stroke. eNeuroscience. 2017;1(1):1–10.

  8. Paciaroni M, Balucani C, Agnelli G, Caso V, Silvestrelli G, Grotta JC, et al. Systemic thrombolysis in patients with acute ischemic stroke and Internal Carotid ARtery Occlusion: the ICARO study. Stroke. 2012;43(1):125–30. https://doi.org/10.1161/strokeaha.111.630624.

    Article  PubMed  Google Scholar 

  9. Saqqur M, Uchino K, Demchuk AM, Molina CA, Garami Z, Calleja S, et al. Site of arterial occlusion identified by transcranial Doppler predicts the response to intravenous thrombolysis for stroke. Stroke. 2007;38(3):948–54. https://doi.org/10.1161/01.STR.0000257304.21967.ba.

    Article  PubMed  Google Scholar 

  10. Rubiera M, Ribo M, Delgado-Mederos R, Santamarina E, Delgado P, Montaner J, et al. Tandem internal carotid artery/middle cerebral artery occlusion: an independent predictor of poor outcome after systemic thrombolysis. Stroke. 2006;37(9):2301–5. https://doi.org/10.1161/01.STR.0000237070.80133.1d.

    Article  PubMed  Google Scholar 

  11. Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet (London, England). 2016;387(10029):1723–31. https://doi.org/10.1016/s0140-6736(16)00163-x.

    Article  Google Scholar 

  12. Fisher M. Occlusion of the internal carotid artery. AMA Arch Neurol Psychiatr. 1951;65(3):346–77.

    Article  CAS  Google Scholar 

  13. Barnett HJM, Taylor DW, Haynes RB, Sackett DL, Peerless SJ, Ferguson GG, et al. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991;325(7):445–53. https://doi.org/10.1056/nejm199108153250701.

    Article  CAS  PubMed  Google Scholar 

  14. Collaborators NASCET. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991;1991(325):445–53.

    Google Scholar 

  15. Nakamura M, Okamoto F, Nakanishi K, Maruyama R, Yamada A, Ushikoshi S, et al. Does intensive management of cerebral hemodynamics and atheromatous aorta reduce stroke after coronary artery surgery? Ann Thorac Surg. 2008;85(2):513–9. https://doi.org/10.1016/j.athoracsur.2007.08.056.

    Article  PubMed  Google Scholar 

  16. Tunio AM, Hingorani A, Ascher E. The impact of an occluded internal carotid artery on the mortality and morbidity of patients undergoing coronary artery bypass grafting. Am J Surg. 1999;178(3):201–5.

    Article  CAS  PubMed  Google Scholar 

  17. Caplan LR, van Gijn J. Stroke Syndromes. 3rd ed. Cambridge UK: Cambridge University Press; 2012. p. 364–374.

  18. Leys D. Atherothrombosis: a major health burden. Cerebrovasc Dis. 2001;11(Suppl. 2):1–4.

    Article  CAS  PubMed  Google Scholar 

  19. Caplan LR. Diagnosis and treatment of ischemic stroke. JAMA. 1991;266(17):2413–8.

    Article  CAS  PubMed  Google Scholar 

  20. Tallarita T, Lanzino G, Rabinstein AA. Carotid intervention in acute stroke. Perspect Vasc Surg Endovasc Ther. 2010;22(1):49–57. https://doi.org/10.1177/1531003510380469.

    Article  PubMed  Google Scholar 

  21. Bos D, Ikram MA, Elias-Smale SE, Krestin GP, Hofman A, Witteman JC, et al. Calcification in major vessel beds relates to vascular brain disease. Arterioscler Thromb Vasc Biol. 2011;31(10):2331–7.

    Article  CAS  PubMed  Google Scholar 

  22. • Hong JM, Lee SE, Lee S-J, Lee JS, Demchuk AM. Distinctive patterns on CT angiography characterize acute internal carotid artery occlusion subtypes. Medicine. 2017;96(5):e5722. https://doi.org/10.1097/MD.0000000000005722. A recent study depicting various imaging patterns that depict subtypes of ICAO.

  23. Warlow C, Dennis M, van Gijn J, Hankey GJ, PAG S, Bamford JM, et al. Stroke: A practical guide to management. Oxford: Blackwell Science; 1996.

    Google Scholar 

  24. Tsiskaridze A, Devuyst G, de Freitas GR, van Melle G, Bogousslavsky J. Stroke with internal carotid artery stenosis. Arch Neurol. 2001;58(4):605–9.

    Article  CAS  PubMed  Google Scholar 

  25. Kang D-W, Chu K, Ko S-B, Kwon S-J, Yoon B-W, Roh J-K. Lesion patterns and mechanism of ischemia in internal carotid artery disease: a diffusion-weighted imaging study. Arch Neurol. 2002;59(10):1577–82.

    Article  PubMed  Google Scholar 

  26. Fusco MR, Harrigan MR. Cerebrovascular dissections—a review part I: spontaneous dissections. Neurosurgery. 2011;68(1):242–57.

    Article  PubMed  Google Scholar 

  27. Chang Y-J, Lin S-K, Ryu S-J, Wai Y-Y. Common carotid artery occlusion: evaluation with duplex sonography. Am J Neuroradiol. 1995;16(5):1099–105.

    CAS  PubMed  Google Scholar 

  28. Ferro JM. Cardioembolic stroke: an update. Lancet Neurol. 2003;2(3):177–88.

    Article  PubMed  Google Scholar 

  29. Jovin TG, Gupta R, Uchino K, Jungreis CA, Wechsler LR, Hammer MD, et al. Emergent stenting of extracranial internal carotid artery occlusion in acute stroke has a high revascularization rate. Stroke. 2005;36(11):2426–30.

    Article  PubMed  Google Scholar 

  30. Marder VJ, Chute DJ, Starkman S, Abolian AM, Kidwell C, Liebeskind D, et al. Analysis of thrombi retrieved from cerebral arteries of patients with acute ischemic stroke. Stroke. 2006;37(8):2086–93. https://doi.org/10.1161/01.str.0000230307.03438.94.

    Article  PubMed  Google Scholar 

  31. McBane RD, Hodge DO, Wysokinski WE. Clinical and echocardiographic measures governing thromboembolism destination in atrial fibrillation. Thromb Haemost. 2008;99(5):951–5. https://doi.org/10.1160/th07-12-0734.

    CAS  PubMed  Google Scholar 

  32. Kwak J, Zhao L, Kim J, Park S, Lee D-G, Shim J, et al. The outcome and efficacy of recanalization in patients with acute internal carotid artery occlusion. Am J Neuroradiol. 2014;35(4):747–53.

    Article  CAS  PubMed  Google Scholar 

  33. Blum CA, Yaghi S. Cervical artery dissection: a review of the epidemiology, pathophysiology, treatment, and outcome. Arch Neurosci. 2015;2(4)e26670. https://doi.org/10.5812/archneurosci.26670.

  34. Schievink WI, Mokri B, O'Fallon WM. Recurrent spontaneous cervical-artery dissection. N Engl J Med. 1994;330(6):393–7.

    Article  CAS  PubMed  Google Scholar 

  35. Li J, Shi D, Wei Y, Xiao J, Zhang K, Wang M. Blood flow in the internal carotid artery with common carotid artery–occluding lesions in Takayasu arteritis. J Ultrasound Med. 2010;29(11):1547–53.

    Article  PubMed  Google Scholar 

  36. Sorteberg A, Sorteberg W, Bakke SJ, Lindegaard KF, Boysen M, Nornes H. Cerebral haemodynamics in internal carotid artery trial occlusion. Acta Neurochir. 1997;139(11):1066–73.

    Article  CAS  PubMed  Google Scholar 

  37. Malhotra K, Liebeskind DS. Imaging in endovascular stroke trials. J Neuroimaging. 2015;25(4):517–27. https://doi.org/10.1111/jon.12272.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Nederkoorn PJ, Mali WP, Eikelboom BC, Elgersma OE, Buskens E, Hunink MG, et al. Preoperative diagnosis of carotid artery stenosis: accuracy of noninvasive testing. Stroke. 2002;33(8):2003–8.

    Article  PubMed  Google Scholar 

  39. AbuRahma AF, Pollack JA, Robinson PA, Mullins D. The reliability of color duplex ultrasound in diagnosing total carotid artery occlusion. Am J Surg. 1997;174(2):185–7.

    Article  CAS  PubMed  Google Scholar 

  40. Rundek T. Beyond percent stenosis: carotid plaque surface irregularity and risk of stroke. Int J Stroke. 2007;2(3):169–71.

    Article  PubMed  Google Scholar 

  41. Alexandrov AV. Neurovascular examination: the rapid evaluation of stroke patients using ultrasound waveform interpretation. Wiley; 2013. https://doi.org/10.1002/9781118583906

  42. Ohm C, Bendick PJ, Monash J, Bove PG, Brown OW, Long GW, et al. Diagnosis of total internal carotid occlusions with duplex ultrasound and ultrasound contrast. Vasc Endovasc Surg. 2005;39(3):237–43.

    Article  Google Scholar 

  43. Malhotra K, Conners JJ, Lee VH, Prabhakaran S. Relative changes in transcranial Doppler velocities are inferior to absolute thresholds in prediction of symptomatic vasospasm after subarachnoid hemorrhage. J Stroke Cerebrovasc Dis. 2014;23(1):31–6. https://doi.org/10.1016/j.jstrokecerebrovasdis.2012.08.004.

    Article  PubMed  Google Scholar 

  44. Giller CA, Mathews D, Walker B, Purdy P, Roseland AM. Prediction of tolerance to carotid artery occlusion using transcranial Doppler ultrasound. J Neurosurg. 1994;81(1):15–9.

    Article  CAS  PubMed  Google Scholar 

  45. Ritter MA, Dittrich R, Thoenissen N, Ringelstein EB, Nabavi DG. Prevalence and prognostic impact of microembolic signals in arterial sources of embolism. J Neurol. 2008;255(7):953–61.

    Article  PubMed  Google Scholar 

  46. Goertler M, Blaser T, Krueger S, Hofmann K, Baeumer M, Wallesch C. Cessation of embolic signals after antithrombotic prevention is related to reduced risk of recurrent arterioembolic transient ischaemic attack and stroke. J Neurol Neurosurg Psychiatry. 2002;72(3):338–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Buratti L, Balucani C, Viticchi G, Falsetti L, Altamura C, Avitabile E, et al. Cognitive deterioration in bilateral asymptomatic severe carotid stenosis. Stroke. 2014;45(7):2072–7.

    Article  PubMed  Google Scholar 

  48. Silvestrini M, Paolino I, Vernieri F, Pedone C, Baruffaldi R, Gobbi B, et al. Cerebral hemodynamics and cognitive performance in patients with asymptomatic carotid stenosis. Neurology. 2009;72(12):1062–8.

    Article  CAS  PubMed  Google Scholar 

  49. • Buratti L, Viticchi G, Falsetti L, Balucani C, Altamura C, Petrelli C, et al. Thresholds of impaired cerebral hemodynamics that predict short-term cognitive decline in asymptomatic carotid stenosis. J Cereb Blood Flow Metab. 2016;36(10):1804–12. Recent study providing threshold of cerbral vasomotor reactivity in asymtomatic ICA stenosis patients at risk of cognitive decline.

    Article  PubMed  Google Scholar 

  50. Bash S, Villablanca JP, Jahan R, Duckwiler G, Tillis M, Kidwell C, et al. Intracranial vascular stenosis and occlusive disease: evaluation with CT angiography, MR angiography, and digital subtraction angiography. Am J Neuroradiol. 2005;26(5):1012–21.

    PubMed  Google Scholar 

  51. Skutta B, Fürst G, Eilers J, Ferbert A, Kuhn F-P. Intracranial stenoocclusive disease: double-detector helical CT angiography versus digital subtraction angiography. Am J Neuroradiol. 1999;20(5):791–9.

    CAS  PubMed  Google Scholar 

  52. Hirai T, Korogi Y, Ono K, Nagano M, Maruoka K, Uemura S, et al. Prospective evaluation of suspected stenoocclusive disease of the intracranial artery: combined MR angiography and CT angiography compared with digital subtraction angiography. Am J Neuroradiol. 2002;23(1):93–101.

    PubMed  Google Scholar 

  53. Anzidei M, Napoli A, Zaccagna F, Di Paolo P, Saba L, Marincola BC, et al. Diagnostic accuracy of colour Doppler ultrasonography, CT angiography and blood-pool-enhanced MR angiography in assessing carotid stenosis: a comparative study with DSA in 170 patients. Radiol Med. 2012;117(1):54–71.

    Article  CAS  PubMed  Google Scholar 

  54. Michel P, Ntaios G, Delgado MG, Bezerra DC, Meuli R, Binaghi S. CT angiography helps to differentiate acute from chronic carotid occlusion: the “carotid ring sign”. Neuroradiology. 2012;54(2):139–46.

    Article  PubMed  Google Scholar 

  55. Korogi Y, Takahashi M, Nakagawa T, Mabuchi N, Watabe T, Shiokawa Y, et al. Intracranial vascular stenosis and occlusion: MR angiographic findings. Am J Neuroradiol. 1997;18(1):135–43.

    CAS  PubMed  Google Scholar 

  56. Brinjikji W, Huston J III, Rabinstein AA, Kim G-M, Lerman A, Lanzino G. Contemporary carotid imaging: from degree of stenosis to plaque vulnerability. J Neurosurg. 2016;124(1):27–42.

    Article  PubMed  Google Scholar 

  57. Kilburg C, Scott McNally J, de Havenon A, Taussky P, Kalani MYS, Park MS. Advanced imaging in acute ischemic stroke. Neurosurg Focus. 2017;42(4):E10.

    Article  PubMed  Google Scholar 

  58. de Havenon A, Yuan C, Tirschwell D, Hatsukami T, Anzai Y, Becker K, et al. Nonstenotic culprit plaque: the utility of high-resolution vessel wall MRI of intracranial vessels after ischemic stroke. Case Rep Radiol. 2015;2015

  59. Bouthillier A, Van Loveren HR, Keller JT. Segments of the internal carotid artery: a new classification. Neurosurgery. 1996;38(3):425–33.

    CAS  PubMed  Google Scholar 

  60. Phan TG, Donnan GA, Srikanth V, Chen J, Reutens DC. Heterogeneity in infarct patterns and clinical outcomes following internal carotid artery occlusion. Arch Neurol. 2009;66(12):1523–8.

    Article  PubMed  Google Scholar 

  61. Hart R, Easton J. Dissections of cervical and cerebral arteries. Neurol Clin. 1983;1(1):155.

    CAS  PubMed  Google Scholar 

  62. Siddiq F, Chaudhry SA, Das P, Khatri R, Rodriguez G, Qureshi AI. Occurrence and prognostic significance of cervical pseudodissection phenomenon associated with acute intracranial internal carotid artery occlusion. J Neuroimaging. 2013;23(3):384–90.

    Article  PubMed  Google Scholar 

  63. •• Liebeskind DS, Flint AC, Budzik RF, Xiang B, Smith WS, Duckwiler GR, et al. Carotid I’s, L’s and T’s: collaterals shape the outcome of intracranial carotid occlusion in acute ischemic stroke. J Neurointerv Surg. 2015;7(6):402–7. Recent study differentiating functional and anatomical ICA terminus occlusion patterns and their significance.

    Article  PubMed  Google Scholar 

  64. Flint AC, Duckwiler GR, Budzik RF, Liebeskind DS, Smith WS. Mechanical thrombectomy of intracranial internal carotid occlusion. Stroke. 2007;38(4):1274–80.

    Article  PubMed  Google Scholar 

  65. Bisschops R, Klijn C, Kappelle L, van Huffelen A, Van Der Grond J. Collateral flow and ischemic brain lesions in patients with unilateral carotid artery occlusion. Neurology. 2003;60(9):1435–41.

    Article  CAS  PubMed  Google Scholar 

  66. Hendrikse J, Hartkamp MJ, Hillen B, Mali WP, van der Grond J. Collateral ability of the circle of Willis in patients with unilateral internal carotid artery occlusion. Stroke. 2001;32(12):2768–73.

    Article  CAS  PubMed  Google Scholar 

  67. van Laar PJ, Hendrikse J, Klijn CJ, Kappelle LJ, van Osch MJ, van der Grond J. Symptomatic carotid artery occlusion: flow territories of major brain-feeding arteries 1. Radiology. 2007;242(2):526–34.

    Article  PubMed  Google Scholar 

  68. Lin MP, Tsivgoulis G, Alexandrov AV, Chang JJ. Factors affecting clinical outcome in large-vessel occlusive ischemic strokes. Int J Stroke. 2015;10(4):479–84. https://doi.org/10.1111/ijs.12406.

    Article  PubMed  Google Scholar 

  69. Mokin M, Kass-Hout T, Kass-Hout O, Dumont TM, Kan P, Snyder KV, et al. Intravenous thrombolysis and endovascular therapy for acute ischemic stroke with internal carotid artery occlusion: a systematic review of clinical outcomes. Stroke. 2012;43(9):2362–8. doi:https://doi.org/10.1161/strokeaha.112.655621.

    Article  CAS  PubMed  Google Scholar 

  70. Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 2015;372(24):2285–95. https://doi.org/10.1056/NEJMoa1415061.

    Article  CAS  PubMed  Google Scholar 

  71. Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015;372(24):2296–306. https://doi.org/10.1056/NEJMoa1503780.

    Article  CAS  PubMed  Google Scholar 

  72. Gliem M, Lee JI, Barckhan A, Turowski B, Hartung HP, Jander S. Outcome and treatment effects in stroke associated with acute cervical ICA occlusion. PLoS One. 2017;12(1):e0170247. https://doi.org/10.1371/journal.pone.0170247.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Kim DJ, Kim DI, Byun JS, Jung JY, Suh SH, Kim EY, et al. Intra-arterial thrombolytic therapy for hyperacute ischemic stroke caused by tandem occlusion. Cerebrovasc Dis. 2008;26(2):184–9.

    Article  PubMed  Google Scholar 

  74. Ozdemir O, Bussiere M, Leung A, Gulka I, Lee D, Chan R, et al. Intra-arterial thrombolysis of occluded middle cerebral artery by use of collateral pathways in patients with tandem cervical carotid artery/middle cerebral artery occlusion. Am J Neuroradiol. 2008;29(8):1596–600.

    Article  CAS  PubMed  Google Scholar 

  75. •• Berkhemer OA, Borst J, Kappelhof M, Yoo AJ, van den Berg LA, Fransen PSS, et al. Extracranial carotid disease and effect of intra-arterial treatment in patients with proximal anterior circulation stroke in MR CLEAN. Ann Intern Med, https://doi.org/10.7326/m16-1536. 2017; Recent study that analyzed clinical outcomes and treatment effects in patients with isolated cervical and tandem ICAO.

  76. Lockau H, Liebig T, Henning T, Neuschmelting V, Stetefeld H, Kabbasch C, et al. Mechanical thrombectomy in tandem occlusion: procedural considerations and clinical results. Neuroradiology. 2015;57(6):589–98. https://doi.org/10.1007/s00234-014-1465-5.

    Article  CAS  PubMed  Google Scholar 

  77. Gunka I, Krajickova D, Lesko M, Jiska S, Raupach J, Lojik M, et al. Emergent carotid thromboendarterectomy for acute symptomatic occlusion of the extracranial internal carotid artery. Vasc Endovasc Surg. 2017;51(4):176–82. https://doi.org/10.1177/1538574416674641.

    Article  Google Scholar 

  78. Kiyofuji S, Inoue T, Tamura A, Saito I. Emergent cervical surgical embolectomy for extracranial internal carotid artery occlusion. Acta Neurochir. 2015;157(8):1313–1318; discussion 8-9. https://doi.org/10.1007/s00701-015-2478-5.

    Article  PubMed  Google Scholar 

  79. Luitse MJ, Velthuis BK, Dauwan M, Dankbaar JW, Biessels GJ, Kappelle LJ. Residual high-grade stenosis after recanalization of extracranial carotid occlusion in acute ischemic stroke. Stroke. 2015;46(1):12–5. https://doi.org/10.1161/strokeaha.114.007169.

    Article  PubMed  Google Scholar 

  80. Issawi A, Klopfenstein J. Can a closed carotid artery be reopened? Curr Cardiol Rep. 2015;17(10):85. https://doi.org/10.1007/s11886-015-0638-0.

    Article  PubMed  Google Scholar 

  81. Group EIBS. Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke: results of an international randomized trial. N Engl J Med. 1985;313:1191–200.

    Article  Google Scholar 

  82. Gertler JP, Cambria RP. The role of external carotid endarterectomy in the treatment of ipsilateral internal carotid occlusion: collective review. J Vasc Surg. 1987;6(2):158–67. https://doi.org/10.1067/mva.1987.avs0060158.

    Article  CAS  PubMed  Google Scholar 

  83. Powers WJ, Clarke WR, Grubb RL, Videen TO, Adams HP, Derdeyn CP, et al. Extracranial-intracranial bypass surgery for stroke prevention in hemodynamic cerebral ischemia: the Carotid Occlusion Surgery Study randomized trial. JAMA. 2011;306(18):1983–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  84. Friedman SG, Lamparello PJ, Riles TS, Imparato AM, Sakwa MP. Surgical management of the patient with bilateral internal carotid artery occlusion. J Vasc Surg. 1987;5(5):715–8.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurology, West Virginia University - Charleston Division, Charleston Area Medical Center, Charleston, WV, 25301, USA

    Konark Malhotra

  2. Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, 38163, USA

    Nitin Goyal & Georgios Tsivgoulis

  3. Second Department of Neurology, “Attikon” University Hospital, National & Kapodistrian University of Athens, Athens, Greece

    Georgios Tsivgoulis

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  1. Konark Malhotra
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Malhotra, K., Goyal, N. & Tsivgoulis, G. Internal Carotid Artery Occlusion: Pathophysiology, Diagnosis, and Management. Curr Atheroscler Rep 19, 41 (2017). https://doi.org/10.1007/s11883-017-0677-7

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