engleski

Spontana rekanalizacija okluzije unutarnje karotidne arterije:neurovaskularna evaluacija naša dva slučaja

Study objectives: Although spontaneous recanalisation of occluded internal carotid arteries ACI/ has been previously observed and reported, the exact mechanisms including incidence were insufficiently studied. The reason for this is that diagnosis of recanalisation required a conventional catheter angiography, a “gold standard” as well as an invasive procedure for distinguishing total arterial occlusion from sub- occlusion. The exact timing of spontaneous recanalisation remains unclear, although it has most commonly occurred early after a stroke. In addition and although unclear, several mechanisms, including vasospasm, distal embolisation of occlusive clot, and spontaneous clot lysis, have been proposed to explain recanalisation Methods: We present two cases of late spontaneous recanalisation of an acute occluded internal carotid artery, angiographically reported in the Department of neurology Clinical Hospital of Rijeka. Results: Routine follow-up in both cases has shown spontaneous recanalisation of internal carotid artery after which we scheduled both patients for stenting. Conclusion: These and other similar cases described in literature as well as limited usage of angiography in control diagnosis, raise the possibility that the recanalisation in ACI/ is more frequent than previously considered. Noninvasive ultrasound diagnostic is a safe and secure method to be used in proving significant carotid disease. Routine follow – up and serial monitoring of all patients with carotid occlusion is required, especially because of known progression of atherosclerosis in asymptomatic carotid arteries after contralateral endarterectomy intervention. During this time it is possible to determine which patient is to undergo a successful surgical or stenting procedure, and help determine true incidence of recanalisation, in despite of the ambiguity of the recanalisation mechanism. Although both of our patients were treated with low density heparin from the onset, it is not known which role, if any, the anti-platelet and anticoagulant therapy may have in the treatment process of recanalisation. Diagnosing spontaneous recanalisation of occluded extracranical ACI seems to be more frequent than expected bur the mechanism of this phenomenon and an implication is still truly unkonwn.

spontaneous recanalisation; occlusio; internal carotid artery

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