[Endarterectomy for Internal Carotid Artery Occlusion, with an Aberrant Branch of the Internal Carotid Artery Maintaining Blood Flow Distal to the Complete Occlusion:A Case Report].

Doppler sonography accurately identifies occlusion of the internal carotid artery(ICA)and current surgical guidelines do not list an occluded ICA as an indication for carotid endarterectomy(CEA). We encountered an unusual case, for which we performed CEA. The left ICA was occluded by atherosclerosis, and was reconstituted via an aberrant branch of the occipital artery. A 71-year-old man was referred following brain infarction. Carotid duplex sonography(CDS)demonstrated occlusion of his left ICA, with flow in the distal ICA beyond the occlusion("Sandwich stump sign"). 3D computed tomography angiography and cervical angiography diagnosed ICA occlusion with flow in the distal ICA, and the patient underwent CEA. Careful evaluation is required when apparent occlusion of the ICA is detected to avoid overlooking a flow pattern beyond the occlusion and to determine whether repair is possible.