Key result
During transient right internal carotid artery occlusion, cerebral blood flow was maintained sufficiently via the anterior communicating artery, highlighting its role as a potent collateral pathway.
Case Report (n=1)
This case highlights the anterior communicating artery as a highly potent collateral pathway for cerebral circulation during carotid occlusion.
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Should not change carotid occlusion management; hypothesis-generating for AComA collateral potency, needing prospective validation.
Clinical manifestation of carotid occlusive disease is largely dependent on the severity of stenosis and the capability of collateral circulation. However, due to the complexity and difficulty in evaluation, cerebral collateral circulation has, so far, remained underappreciated. We report a patient with advanced extracranial arterial disease (including the right subclavian steal, occlusion of the right external carotid artery, and severe stenosis of the left vertebral artery), who underwent transient right internal carotid artery occlusion during carotid intervention. Throughout the occlusion, the flow into the right hemisphere (monitored by transcranial Doppler ultrasound in the right middle cerebral artery) was sufficient despite almost totally dependent on the anterior communicating artery, which highlights its role as the most potent collateral pathway.
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Špaček et al. (2014) conducted a case report in Advanced extracranial arterial disease (n=1). Transient right internal carotid artery occlusion was evaluated on Flow into the right hemisphere monitored by transcranial Doppler ultrasound. During transient right internal carotid artery occlusion, cerebral blood flow was maintained sufficiently via the anterior communicating artery, highlighting its role as a potent collateral pathway.
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