External Carotid Artery Revascularisation: An Important procedure in the kitty of a Vascular surgeon

PIX 1:ECA ENDARTRECTOMY WITH PATCH PLASTY

PIX 2:ASCN.AORTA TO ECA BYPASS WITH SILVER DACRON GRAFT


External carotid artery serves as an important collateral to the brain in cases where internal carotid artery(ICA) gets occluded.Christopher .Zarins has done a lot of work on external carotid revascularization.Its an established fact that ECA(external carotid artery)carries 30%blood to the brain in cases where ICA gets occluded.ECA therefore serves as an important collateral to brain in such situations.

There are instances wherein the patient is symptomatic inspite of the fact that the ICA is occluded.The patient may still have lateralizing symptoms pertaining to the territory of the otherwise occluded internal carotid artery.

Many physicians still feel as to what is the cause of the symptoms with the ICA of the concerned cerebral hemisphere being occluded.It becomes mandatory for the concerned physician to look for the status of the ECA if the ICA is occluded and the patient has recurrent symptoms pertaining to the territory of the concerned cerebral hemisphere.Its not uncommon to come across an ECA with significant stenosis which may well be the source of emboli leading to recurrent TIA’S. There are also been instances where the Common carotid artery and ICA of the same side are occluded with a narrowed patent lumen of the ECA.Even these patients can be symptomatic for the reason that there is no forward flow in the ECA leading to recurrence of symptoms.

We report to you two cases done by us with a follow-up period of more than a year.Both these patients are doing fine and are asymptomatic till date.One of these patients had significant ECA stenosis with ipsilateral ICA occlusion.The other patient had both CCA and ICA occlusion with a patent ECA.Both these patients were symptomatic and had recurrent lateralizing symptoms before they approached us.

We did an ECA endartrectomy in the first case and a Aorto-ECA bypass with graft in the second case.This second case also had significant triple vessel disease of the coronaries.Therefore we did a CABG along with it.



NOTE:The external carotid artery (ECA) is an important collateral pathway in patients with ipsilateral internal carotid artery (ICA) occlusion and recurrent symptoms. An ipsilateral ECA revascularization can improve cerebral perfusion or eliminate the source of emboli.