Carotid angioplasty in the management of external carotid artery stenosis associated with an occluded internal carotid artery.

The author describes the surgical treatment of 14 patients in whom angiography demonstrated total occlusion of the internal carotid artery (ICA) associated with stenosis at the origin of the ipsilateral external carotid artery (ECA). Each patient underwent ECA endarterectomy followed by an angioplasty to enlarge the ECA outflow tract by incorporating the ICA stump into the proximal ECA. Nine patients subsequently underwent superficial temporal-middle cerebral artery anastomosis. There was no mortality or permanent neurological morbidity. This method of treating ECA stenosis is recommended because it is simple and effective and because it simultaneously eliminates the ICA stump as a potential source of cerebral emboli.