Treatment of chronic internal carotid artery occlusion by ipsilateral external carotid endarterectomy

Chronic complete occlusion of the internal carotid artery (ICA) is a common and important cause of ischemic cerebrovascular disease, which can be treated in many ways: antithrombotic and anticoagulant agents, direct or indirect procedure for revascularization. However, there is still no evidence to prove which method is the most effective. Here we reported a case showed the successful endarterectomy of the external carotid artery (ECA) for a chronic complete occlusion of ICA patient. A 50-year-old male patient presented with progressively aggravated left-sided limb weakness and limb cold feeling. Digital subtraction angiography (DSA) showed ICA occlusion and ipsilateral ECA stenosis. The right ECA compensated for blood supply to the middle cerebral artery (MCA) through the accessory meningeal artery and ophthalmic artery. The patient was treated by endarterectomy of ipsilateral ECA (ECEA). In the second day after operation, the symptom was improved significantly. Surprisingly, both ICA and ECA were recanalized and the metabolism of the affected brain tissue was also increased. In conclusion, patients with chronic complete occlusion, ECEA would also be an effective therapeutic method.