AIMS. The aim of this study was to evaluate the diagnostic attitude and the results obtained after surgery in cases of pseudo-occlusions of the carotid artery.

PATIENTS AND METHODS Between 1995 and 2000, 13 cases of pseudo-occlusion of the internal carotid artery were performed (3.06% of carotid surgery carried out). Diagnostic criteria were as follows. Echo-Doppler: complete occlusion with its origin in the internal carotid artery, damped distal signal; arteriography: occlusion with its origin in the internal carotid artery, filiform distal part, string-sign. Clinical presentation was: 53.84% cerebral infarction, 23.07% TIA and 23.07% were asymptomatic. The 13 patients were submitted to echo-Doppler and nine were examined using arteriography. Two patients were operated on without arteriography because of unstable neurological clinical features. A surgical exploration was performed in 100% of the cases.

RESULTS In seven cases, revascularisation of the internal carotid artery was carried out (53.84%) and in six cases it was ligated (46.16%). Echographic monitoring (from 1-4 years, average 2 years) showed permeability in the seven revascularised cases; in one case restenosis was detected between 31-50% at 2 years’ follow up. In the clinical controls (from 2 months to 4 years, average 30 months), one patient who was not revascularised was seen to have symptoms of TIA at one year and two months.

DISCUSSION Since neither arteriography nor echo-Doppler can predict when it will be possible to revascularise the internal carotid artery, and because we did not observe an increase in surgical morbidity-mortality, we believe surgical exploration is useful. In our study 53.84% of the series were successfully revascularised.

Objetivo Valorar la actitud diagnóstica y los resultados de la cirugía en las pseudooclusiones carotídeas.

Pacientes y métodos Entre 1995 y 2000 se trataron 13 pseudooclusiones de carótida interna (3,06% de la cirugía carotídea). Los criterios diagnósticos fueron: eco-Doppler: oclusión completa origen carótida interna, señal distal amortiguada; arteriografía: oclusión origen carótida interna, parte distal filiforme, string-sign. La presentación clínica fue: 53,84%, infarto cerebral; 23,07%, AIT; y el 23,07%, asintomática. En los 13 pacientes se practicó eco-Doppler y en nueve se realizó arteriografía. Dos pacientes se intervinieron sin arteriografía por presentar clínica neurológica inestable. Se realizó exploración quirúrgica en el 100% de los casos.

Resultados En siete casos se pudo revascularizar la carótida interna (53,84%), en seis se procedió a la ligadura de la misma (46,16%). Los controles ecográficos (de 1-4 años, media 2 años) muestran permeabilidad de los siete casos revascularizados; en un caso se detectó reestenosis entre 31-50% a los 2 años de seguimiento. En los controles clínicos (de 2 meses a 4 años, media 30 meses), un paciente no revascularizado presentó clínica en forma de AIT al año y 2 meses. Comentarios. Ante el hecho de que ni la arteriografía ni el eco-Doppler nos pueden predecir cuándo la carótida interna podrá revascularizarse, y dado que no observamos un aumento de la morbimortalidad quirúrgica, consideramos indicada la exploración quirúrgica. Un 53,84% de la serie pudieron revascularizarse.