Spontaneous Recanalization after Complete Occlusion of the Common Carotid Artery with Subsequent Embolic Ischemic Stroke

Abstract

Introduction: Acute carotid artery occlusion carries a high morbidity and mortality. Acute angioplasty and stenting is a feasible option
with little known about the long term outcome. Limiting factor for this approach is hyperperfusion syndrome or hemorrhagic infarction. Spontaneous early or late recanalization for extracranial vessel is in the range of 5% -30%, with no well defined clinical outcome
data. We describe a case of spontaneous common carotid recanalization.
Case Report: An 88 year old man presented with right sided weakness, global aphasia and visual field loss and was discovered to have
common carotid occlusion at its origin. Within 12 hours of symptom onset patient improved neurologically to his baseline exam and
repeat imaging demonstrated spontaneous recanalization. This was followed symptomatic occlusion of left middle cerebral artery The
patient was treated with multimodality approach resulting in complete revascularization of the middle cerebral artery and angioplasty
and stent placement of the internal carotid artery. Patient had a good neurological outcome at 3 months followup.
Conclusion: The present case report demonstrates the risk of spontaneous recanalization acutely in patients presenting with common
carotid artery occlusion and associated risk of embolic strokes. In such a patient,concomitant treatment for intracranial occlusion and
extracranial high grade stenosis may be performed safely after 30 hours from the initial symptom onset