The so-called atheromatous pseudoocclusion of the internal carotid artery

Abstract

The term "atheromatous pseudoocclusion" of the internal carotid artery (ICA) describes an extreme type of stenosing lesion which, during non-invasive procedure and conventional angiography is easily misdiagnosed as complete occlusion. Its recognition requires special sonographic and angiographic techniques. Nine subjects with pseudoocclusion could be observed during the last 12 months, most of them presenting minor strokes. Infarction suggesting a haemodynamic pathogenesis were demonstrated in seven of the cases by computed tomography. In seven of the eight subjects that were operated on, ICA reconstruction was successful. Since pseudoocclusion of the ICA is likely to progress rapidly to definite occlusion, the patient is severely jeopardized from periocclusive embolism into the major brain arteries. Immediate diagnostic clarification and emergency endarterectomy are mandatory.

Carotid Near-Occlusion: A Comprehensive Review, Part 1—Definition, Terminology, and Diagnosis

“…1,2,4,6,[9][10][11][12][13][14][15][16][17][18][19][20]28,31,45,[47][48][49][50][51]55,59,60,62,64,68,69,71,72 Pseudo-Occlusion. The term "pseudo-occlusion" was used for cases with raised intracranial pressure by Newton and Couch in 1960.…”

“…Images from Sekhar et al can be called "near-occlusion with full collapse." "Pseudo-occlusion" has been used for the appearance of a collapsed artery, [1][2][3][4][5][6][7][8][9]11,[13][14][15][16][17][18][19][20][45][46][47][48][56][57][58][59][60][61][62][65][66][67][68][69][70] but also quite literally when diagnosis changed from occlusion to patent after re-review (not necessarily with distal collapse. 10,12,55,63,64,81 String Sign.…”

“…1 Various terms have been used to describe near-occlusion, which can mislead students or those doing literature searches: near-occlusion (or "near total occlusion" [45][46][47][48][49][50][51] ), pseudo-occlusion, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]43,45,47,48,50-70 string sign, 1-5,7,9-13,16,18-20,22,24,26,30, 11,12,18,45 99% stenosis, 66 hairline residual lumen, 20,43 and incomplete occlusion. 1 Calculating percentage stenosis for carotid near-occlusion is fallacious, and near-occlusion assessment is advised before measuring for percentage stenosis.…”

Carotid Near-Occlusion: A Comprehensive Review, Part 2—Prognosis and Treatment, Pathophysiology, Confusions, and Areas for Improvement

“…1 In 1983, Ringelstein et al 6 concluded that "immediate diagnostic clarification and emergency endarterectomy are mandatory" for near-occlusion with full collapse, diagnosed with low-flow findings on continuous-wave Doppler. However, this opinion was not an observed high risk of recurrent stroke but was based on that of 9 patients: Two had crescendo TIA at baseline, 2 had crescendo amaurosis fugax at baseline, and 2 rapidly progressed to occlusion.…”

“…In fact, no risk of recurrent stroke was reported. 6 In 1989, O'Leary et al 7 reported that of 9 patients with near-occlusion (most likely with full collapse) who did not undergo carotid endarterectomy, 2 had an angiographic stroke and 3 had a recurrent ipsilateral stroke within 1 year. Presumably, the angiographic strokes affected further management.…”