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Internal carotid artery occlusion or subocclusion: Contemporary diagnostic challenges: Case report

Popov Petar (Klinika za vaskularnu hirurgiju, Institut za kardiovaskularne bolesti 'Dedinje', Beograd)
Radak Sandra (Klinika za vaskularnu hirurgiju, Institut za kardiovaskularne bolesti 'Dedinje', Beograd)
Ilijevski Nenad (Klinika za vaskularnu hirurgiju, Institut za kardiovaskularne bolesti 'Dedinje', Beograd)
Nenezić Dragoslav (Klinika za vaskularnu hirurgiju, Institut za kardiovaskularne bolesti 'Dedinje', Beograd)
Babić Srđan (Klinika za vaskularnu hirurgiju, Institut za kardiovaskularne bolesti 'Dedinje', Beograd)
Tanasković Slobodan (Klinika za vaskularnu hirurgiju, Institut za kardiovaskularne bolesti "Dedinje", Beograd)
Tasić Nebojša (Klinika za vaskularnu hirurgiju, Institut za kardiovaskularne bolesti 'Dedinje', Beograd)
Radak Đorđe (Klinika za vaskularnu hirurgiju, Institut za kardiovaskularne bolesti 'Dedinje', Beograd)

Introduction. Measurement of vessel stenosis using ultrasonography or magnetic resonance is still the principal method for determining the severity of carotid atherosclerosis and need for endarterectomy. Case Outline. A 56-year-old male was admitted to the Cardiovascular Institute 'Dedinje' due to a clinically asymptomatic restenosis of the operated left internal carotid artery (ICA). Angiography and magnetic resonance angiography (MRA) in previous hospitalization had revealed occluded right ICA. However, routine duplex ultrasonography revealed a highgrade restenosis (85%) of the left ICA and subocclusion of the right ICA by an ulcerated plaque (confirmed on repeated MRA). Conclusion. Selective arteriography examination could misrepresent the degree of stenosis especially in patents with the ICA that seems to be occluded. MRA is considered the method of choice for identifying pseudo-occlusions of ICA.

Keywords: carotid artery, arteriography, ultrasonography