Common carotid artery occlusion: Evaluation with duplex sonography

PURPOSE: To demonstrate the efficacy of carotid duplex ultrasound to diagnose common carotid artery occlusion (CCAO) and to define the clinical features of CCAO. METHODS: We reviewed 5400 carotid duplex ultrasonograms obtained over a 7-year period for suspected carotid artery disease. In cases of CCAO, medical records were reviewed. RESULTS: Thirteen cases (0.24%) of CCAO were diagnosed by carotid duplex ultrasonography, including five cases of isolated CCAO. Seven eases were proved by cerebral angiography. Cerebral angiography failed to demonstrate patent internal carotid arteries in two cases of isolated CCAO. Mean age of onset was 67 ± 9 years. The main clinical presentation was stroke in nine cases (69%). The most common vascular risk factors were hypertension (62%) and heart diseases (54%). Three patients had a history of radiation therapy to the neck. Two of five patients with isolated CCAO had major stroke, with good recovery in one, whereas five of eight patients with CCAO had major stroke; among them, only one had good recovery. CONCLUSION: Patients with isolated CCAO may have a better outcome than patients with CCAO. Duplex sonography, particularly with color-coded flow imaging, provides an accurate examination to define the patency of the arteries distal to the carotid bifurcation. The clinical features of CCAO are similar to those of internal carotid artery occlusion except for the low prevalence of CCAO.