[Diagnostic and therapeutic management of pseudo-occlusions of the carotid artery]. / Manejo diagnóstico y terapéutico de la pseudooclusién carotídea.

AIMS: The aim of this study was to evaluate the diagnostic attitude and the results obtained after surgery in cases of pseudo occlusions of the carotid artery. PATIENTS AND METHODS: Between 1995 and 2000, 13 cases of pseudo occlusion of the internal carotid artery were performed (3.06% of carotid surgery carried out). Diagnostic criteria were as follows. Echo Doppler: complete occlusion with its origin in the internal carotid artery, damped distal signal; arteriography: occlusion with its origin in the internal carotid artery, filiform distal part, string sign. Clinical presentation was: 53.84% cerebral infarction, 23.07% TIA and 23.07% were asymptomatic. The 13 patients were submitted to echo Doppler and nine were examined using arteriography. Two patients were operated on without arteriography because of unstable neurological clinical features. A surgical exploration was performed in 100% of the cases. RESULTS: In seven cases, revascularisation of the internal carotid artery was carried out (53.84%) and in six cases it was ligated (46.16%). Echographic monitoring (from 1 4 years, average 2 years) showed permeability in the seven revascularised cases; in one case restenosis was detected between 31 50% at 2 years follow up. In the clinical controls (from 2 months to 4 years, average 30 months), one patient who was not revascularised was seen to have symptoms of TIA at one year and two months. DISCUSSION: Since neither arteriography nor echo Doppler can predict when it will be possible to revascularise the internal carotid artery, and because we did not observe an increase in surgical morbidity mortality, we believe surgical exploration is useful. In our study 53.84% of the series were successfully revascularised.

Use of ultrasound contrast in the diagnosis of carotid artery occlusion.

OBJECTIVE: The purpose of this study was to evaluate the use of an echo-enhancing agent in patients with carotid artery occlusion to improve the sensitivity and specificity of carotid color flow ultrasonography. METHOD: Between January 1997 and December 1998, a prospective study involving 85 cases of carotid artery occlusion in 84 patients was carried out. After a baseline duplex ultrasonography (DU) diagnosis, a second (DU) along with an echo-enhancement agent (SHU-508-A [Levovist]) study was carried out (echo enhancement ultrasonography diagnosis [DUEE]). In 82 cases, a contrast angiography was performed to confirm the diagnosis, whereas in the other three cases the diagnoses were confirmed with surgery. RESULTS: From the 85 internal carotid artery occlusions diagnosed at the initial DU examination, seven came out to be false occlusions in the DUEE examination (8,2%). There was a 100% correlation of the cases between the DUEE examination and the contrast angiography in the 82 cases in which this had been done. In three of the cases, the diagnosis was confirmed surgically because these displayed severe stenoses according to the DUEE studies in symptomatic patients, and so they required urgent treatment. CONCLUSIONS: The DUEE study is a potent diagnosis tool that allows the differentiation between true carotid artery occlusions and pseudo-occlusions.