PSEUDO-OCCLUSION OF THE INTERNAL CAROTID-ARTERY - REPORT OF 15 CASES AND REVIEW OF THE LITERATURE

Pseudo-occlusion of the internal carotid artery represents a difficult diagnostic problem. Meticulous investigation is mandatory whenever th ere is any suspicion of pseudo-occlusion, since it can easily be remov ed with endoarterectomy. Fifteen patients were selected in the last tw elve years from those participating in a prospective study on the natu ral history of total occlusion of the internal carotid artery. The mea n follow-up was 4.2 years (ranging from 1 to 12). Pseudo-occlusion was diagnosed by duplex examination in the presence of a continuous signa l with filling in of the spectral waveform window and no pulsatile flo w. Arteriography showed a segmental occlusion of the internal carotid artery with reconstitution of flow in the distal portion of the vessel . Operations were performed under general anesthesia with EEG monitori ng. Intraluminal shunt was necessary in only one patient. Patch closur e of the arteriotomy was performed in two patients. All patients were put on Ticlopidin ''sine die'' after the operation. No mortality or st rokes occurred in the perioperative period; Two patients presented wit h ipsilateral TIA after 7 months and one year, respectively We conclud e that: the incidence of this disease is low; the performance of duple x scan in combination with arteriography is essential in order to obta in the diagnosis of pseudo-occlusion; a strong suspicion of carotid ps eudo-occlusion should always spring to mind when an apparently occlude d carotid artery continues to be symptomatic or when, in asymptomatic patients, there is some discordance between angiography and Doppler or duplex scan findings; pseudo-occlusion should be considered an indica tion for urgent operation only in selected symptomatic patients.