Patients with completely occluded internal carotid arteries are ordinarily not considered to be candidates for carotid reconstructive surgery. This paper, however, demonstrates the rich anatomical collaterals between the external and internal carotid arteries that become more prominent with internal carotid occlusion. Stenosis of the external carotid in accompaniment with internal carotid occlusion thus becomes a significant lesion.
We have operated on 45 such patients in whom the primary therapeutic procedure was endarterectomy of the external carotid. Additional intracerebral blood flow achieved by opening the external carotid in these patients has resulted in significant beneficial clinical effects. A widely patent external carotid can contribute to increased cerebral flow in the presence of various patterns of intracranial and extracranial occlusive disease.
Connolly JE, Stemmer EA. Endarterectomy of the External Carotid ArteryIts Importance in the Surgical Management of Extracranial Cerebrovascular Occlusive Disease. Arch Surg. 1973;106(6):799-802. doi:10.1001/archsurg.1973.01350180037012