The classical clinical features and treatment of carotid insufficiency secondary to vascular lesions in the neck have been well documented.1,4 Our purpose in this paper is to present 3 cases, each of which presented different etiological factors and each of which had to have a tailored surgical procedure to satisfy the respective situation. Fortunately, our neurological and neurosurgical colleagues are alert to the fact of cervical vascular disease as an etiological factor in cerebral catastrophies. One wrote in a recent paper, "It cannot be stressed too strongly that modern adequate therapy in the stroke patient rests upon the solid bedrock of a promptly established, precise, focal anatomical diagnosis."3
In the following case studies the segmental anatomical pathology was made manifest by virtue of angiography, with a resultant picture of occlusive vascular disease. However, surgical exploration demonstrated in one patient periadventitial fibrosis of a congenital stenotic internal carotid artery,
WAGNER M, BENJAMIN HB, ZEIT W. Carotid Artery Insufficiency: Variable Etiological Factors with Tailored Surgical Treatment. Arch Surg. 1961;82(5):679–682. doi:10.1001/archsurg.1961.01300110041007
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