Stent Placement for Severe Stenosis of the Left Common Carotid Artery with Internal-to-External Carotid Steal

Abstract

We report the case of a 64-year-old male with internal carotid artery (ICA)-to-external carotid artery (ECA) steal due to severe stenosis of the common carotid artery (CCA). Left CCA occlusion was initially diagnosed on 3-dimensional time-of-flight magnetic resonance angiography, but digital subtraction angiography revealed severe stenosis of the left CCA and retrograde flow through the left ICA feeding the left ECA. Diverted blood flow from ECA to ICA in cases with occlusion or severe stenosis of the CCA represents a well-known alternative collateral flow pattern called ECA-to-ICA steal. However, collateral flow from ICA to ECA is rarely observed and may be termed ICA-to-ECA steal. We treated CCA stenosis in our patient by carotid artery stenting (CAS) because his CCA stenosis had been gradually progressing since the initial ischaemic attack. Antegrade ICA flow subsequently recovered. To the best of our knowledge, this is the first report of ICA-to-ECA steal normalised by the treatment of CCA stenosis using CAS. i 2014 S. Karger AG, Basel

Adventitia Layer-Focused Microsurgical Flow Reconstruction for Long-Segment Tubular Stenosis of the Cervical Segment (C1) Internal Carotid Artery: Clinical Valuable Experience in 20 Cases

“…We observe a parallel in the migraine episodes experienced by patients with ICA stenosis, which we posit to stem from a flow diversion or steal phenomenon towards the external carotid artery (ECA). This is akin to findings by Herial et al and Kimura et al, who describe headaches and facial pain resulting from altered hemodynamics due to significant ICA stenosis [24,25]. Our clinical data suggest that similar to the flow-diversion headaches detailed by Herial et al, the migrainous attacks in our patients may be attributed to excessive blood diversion to the ECA due to tubular stenosis in the ICA.…”