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September 23/30, 1998

Occlusion of the Internal Carotid Artery: Reopening a Closed Door?

Author Affiliations

From the Division of Cerebrovascular Diseases, Department of Neurology, University of Iowa College of Medicine, Iowa City.

JAMA. 1998;280(12):1093-1094. doi:10.1001/jama.280.12.1093

The internal carotid artery (ICA) is the primary conduit for blood to reach the cerebral hemispheres. Through its major branches, the anterior cerebral artery, the middle cerebral artery, and the anterior choroidal artery, the ICA supplies both cortical and deep structures. Because of the extensive vascular territory of the ICA, its occlusion has the potential to cause a multilobar infarction and serious neurologic injury. Although some patients with occlusion of the ICA can have a catastrophic brain injury, others have only a transient ischemic attack or a minor stroke. Still others have no symptoms and the occluded artery is found incidentally. The wide range of clinical consequences means that additional factors influence outcomes after occlusion of the ICA. Foremost is the presence of adequate collateral channels including anastomoses with branches of the external carotid artery, a patent circle of Willis, and prominent pial vessels.