Common Carotid Artery Occlusion Treatment Case Reports [Neurosurgery Wiki]

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====== Common Carotid Artery Occlusion Treatment Case Reports ======

===== 🩺 1. Endovascular Recanalization (Two-Case Series) =====
**Jung‑Chi Hsu et al., 2020 (CVIR Endovascular)**  
Two patients with symptomatic total CCAO were treated with:
  * Percutaneous transluminal angioplasty
  * Carotid stenting with distal protection
  * Intravascular ultrasound (IVUS) guidance

**Outcome:**  
Technical success with symptom resolution and patent stents on follow-up.

===== 🔧 2. Retrograde Ring-Stripper Endarterectomy =====
**Qingjun Jiang et al., 2022 (Frontiers in Surgery)**  
67-year-old woman with limb-shaking TIA underwent:
  * Retrograde ring-stripper endarterectomy for long-segment CCAO

**Outcome:**  
Restored cerebral perfusion and complete symptom resolution.

===== 🔪 3. Carotid Endarterectomy with Partial Sternotomy =====
**Surgical Neurology International**  
Two cases of symptomatic CCAO treated with:
  * Carotid endarterectomy (CEA)
  * L-shaped partial sternotomy for proximal exposure

**Outcome:**  
Uncomplicated recovery with mRS ≤ 3 at discharge.

===== 🔗 4. Hybrid Technique: Ring-Stripper CEA + Stenting =====
**Journal of Vascular Surgery (2007–2008)**  
Described hybrid approach combining:
  * Ring-stripper-assisted CEA
  * Carotid artery stenting

**Outcome:**  
Successful revascularization and improved flow in symptomatic CCAO.

===== 🔄 5. Surgical Bypass (Axilloaxillary / Subclavian–ICA) =====
**Multiple reports (ScienceDirect, ~2005)**  
Bypass procedures performed:
  * Axilloaxillary bypass for bilateral CCAO
  * Subclavian–ICA bypass with saphenous vein grafts

**Outcome:**  
Durable graft patency and stroke prevention in mid-term follow-up.

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===== 📊 Summary Table =====

^ Approach ^ Case(s) ^ Outcome ^
| Endovascular angioplasty + stenting | 2 cases | Symptom relief, stent patency |
| Retrograde ring-stripper CEA | 1 case | Limb-shaking TIA resolved |
| CEA + partial sternotomy | 2 cases | Safe access, good outcome |
| Hybrid CEA + stenting | Multiple | Effective revascularization |
| Subclavian or axilloaxillary bypass | ≥8 patients | Durable long-term patency |


===== 🧠 Takeaway =====
  * **Endovascular therapy** is feasible and minimally invasive for selected cases.
  * **Hybrid and surgical approaches** remain essential for complex proximal occlusions.
  * Individualized treatment depends on anatomy, symptoms, and collateral status.

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