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“The importance of being external”: review of the literature of the rare phenomenon of common carotid occlusion with bulb reverse-crossed stenosis and external collaterals activation. Is still correct speaking about carotid steal?

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Abstract

Common carotid artery occlusion (CCAO) is a rare phenomenon associated with the development of neurological symptoms. In CCAO, diversion of blood flow from the external carotid artery (ECA) to the internal carotid artery (ICA) via the carotid bulb (CB) may occur. This pathway activation has been called “carotid steal”. Starting from a particular case we describe the ECD finding of a complete occlusion of CCA with patency of ICA and ECA. In case of occlusion of CCA, inversion of the ECA flow may occur, towards the ICA, and it can be damped by a significant stenosis crossed in retrograde direction that may concur to maintain the pressure balance between the two circulations. Usually, this particular compensation can guarantee normal flow velocities in middle cerebral arteries without signs of activation of anterior collateral pathways. In this review we underline the protective role of ECA and we propose a new definition for this phenomenon. The ECA may provide blood to the cerebral circulation through several anastomotic secondary channels. Finally, only with an extensive knowledge of hemodynamic information of all intracranial and extracranial arteries, including ECA, we can estimate cerebral ischemic risk of the patient and choose the correct management of this occlusion.

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Abbreviations

ACoA:

Anterior communicating artery

BA:

Basilar artery

CCA:

Common carotid artery

CCAO:

Common carotid artery occlusion

CEUS:

Contrast-enhanced-ultrasound

ECA:

External carotid artery

ECD:

EchoColorDoppler

ICA:

Internal carotid artery

MCA:

Middle cerebral artery

PCoA:

Posterior communication artery

PSV:

Peak systolic velocity

SA:

Subclavian artery

TCCD:

Transcranial color coded doppler

VA:

Vertebral artery

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Acknowledgements

We thank the Italian Society of Neurosonology and Cerebral Hemodynamic (SINSEC) group for training, education and general supervision of the research group.

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Authors and Affiliations

  1. Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), Università degli Studi di Palermo, piazza delle Cliniche 2, 90127, Palermo, Italy

    Giuseppe Miceli, Antonino Tuttolomondo, Mariachiara Velardo, Sonia Poma & Antonio Pinto

  2. Department of Radiology, University of Palermo, Palermo, Italy

    Francesco Bencivinni

Authors
  1. Giuseppe Miceli
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  2. Antonino Tuttolomondo
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  3. Mariachiara Velardo
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  4. Francesco Bencivinni
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  5. Sonia Poma
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  6. Antonio Pinto
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Corresponding author

Correspondence to Giuseppe Miceli.

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Ethical approval and consent to participate

Not applicable.

Consent for publication

The patient gave her consensus to include her case report into this paper.

Availability of data and materials

The data and images used in the current study are available from the corresponding author upon reasonable request.

Competing interests

The authors declare that they have no competing interests.

Funding

None.

Authors’ contribution

GM performed and interpreted EchocolorDoppler exams and gave the main contribution to manuscript preparation and revisions. MV interpreted EchocolorDoppler images and collaborated to manuscript and figures preparation. SP collaborated in writing manuscript and searching references. AT and AP collaborated to manuscript revisions. FB analysed and interpreted Angio TC images, performed 3D reconstructions and collaborated to manuscript revisions. All authors read and approve the final manuscript.

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Miceli, G., Tuttolomondo, A., Velardo, M. et al. “The importance of being external”: review of the literature of the rare phenomenon of common carotid occlusion with bulb reverse-crossed stenosis and external collaterals activation. Is still correct speaking about carotid steal?. J Ultrasound 25, 435–442 (2022). https://doi.org/10.1007/s40477-021-00644-1

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  • DOI: https://doi.org/10.1007/s40477-021-00644-1

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