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Posts Tagged ‘unilateral vs bilateral carotid occlusion’

In early days of  medical school we were taught there is an important vascular grade separator in the base of  brain .God  would not have created this circle (of Willis ) without any purpose  , he must have designed it for a reason.

circle of willisHow good is the circle of  Willis to prevent a stroke ?

Unfortunately , we have not answered  this in detailed manner . Obviously  it can’t prevent all strokes however , it is strongly  believed it can  abort  many of  them .My guess would be but for its presence many of episodes of TIA, syncope ,near syncope would end up in stroke with various degree of deficit.

The other factor that tests the efficiency of circle  of Willis is the acuteness of the vascular insufficiency.Chronic carotid occlusion  as expected are well  tolerated . We failed to respect  this natural hemodynamic  sharing  and indulged in so many  unilateral carotid interventions with dubious results .

Here is a paper  with fresh  knowledge from Dr  Seemant Chaturvedi ,  Miamai , Florida .Hats off to the authors.

Are the Current Risks of Asymptomatic Carotid Stenosis Exaggerated?Further Evidence Supporting the CREST 2 Trial  Seemant Chaturvedi,  Ralph L. Sacco,JAMA Neurol. Published online September 21, 2015.

Internal carotid artery (ICA) occlusion when occurring in a chronic fashion  could be as benign as a small peripheral vessel occlusion .(Of course they can be symptomatic)

For all those patients with unilateral total carotid disease , let us thank the “circle of Hope” which if regulated by God whom should we fear ?

Secondary collaterals in stroke

There is one more collateral system that connects extra cranial branches of carotid to intra cranial  circulation though Opthalmic artery and leptomeningeal collaterals .This could help prevent or mitigate cerebral Ischemia . A rare review about this important concept worth reading for both cardiologist and neurologists( David S. Liebeskind Collateral Circulation  Stroke. 2003;34:2279–2284)

Further reading

carotid stenting crest 1 crest 2 ACAST ACSE CEA

cartoid stenosis current management stenting

http://www.amazon.com/Carotid-Artery-Stenosis-Treatments-Neurological/dp/0824754174

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