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Saturday, 2 April 2016

CASE 371: BCCAO (BILATERAL COMMON CAROTID ARTERY OCCLUSION) Dr PHAN THANH HẢI. MEDIC MEDICAL CENTER, HCMC, VIETNAM



Man 38yo, high BP with headache,





 psoriasis only on hands (see foto of hands),



 in  routine ultrasound screening of  vascular neck detected  bilateral common carotid  stenosis completely with dilated  vertebral arteries  both 2 sites (see  US 1,2= R-L.CCA, US 3-4=R-L/ I+ECA, US 6-7= R-L/ Vert.A).










MSCT Angio showed that completely obstruction of right and left CCA.


Patient has not loss of vision or any neurological symptom.

Blood test on DDMERE [D-DIMER] was in normal level of 270 ng/mL.

Discussion: Do you see the BCCAO case  looked like this ? What is the cause of disease?
Reference: One case of BCCAO.



3 comments :

VIETNAMESE MEDIC ULTRASOUND DIAGNOSIS said...

Many thanks to Dr Phan Thanh Hải with this excellent case, because it is very rare.
In contrast to the large amount of data in the literature about internal carotid artery occlusion (ICAO), there is little information regarding the incidence, clinical presentation, ultrasound findings, haemodynamics, causes, and treatment of common carotid artery occlusion (CCAO). Bilateral common carotid artery occlusion (BCCAO) is much rarer than that of the isolated common carotid artery occlusion (ICCAO). In the majority of published case series, the major cause
of CCAO is atherosclerosis. A higher prevalence of Takayasu’s arteritis was reported in the Asian population. In literature, only few cases of BCCAO are reported. Contrast with significant carotid stenosis, CCAO is a rare cause of cerebrovascular events, the patient is usually asymptomatic.
Until now, after ten years focus on vascular ultrasound, I only found one case (symptomatic).
CCAO is generally associated with occlusion of the distal vessels (ICA and ECA)). In some cases, blood flow in the ICA and ECA is maintained by collateral circulation via extracranial branches through the retrograde external carotid artery.
Recognising the patency of the distal vessels is very important because it may allow for effective surgical revascularization (if no patency, only medical treatment). It must note on report about the patency of the distal vessels.

Dr Nguyễn Quang Trọng.
FV Hospital – HCM city.
Email: docteurtrong@yahoo.com
docteurtrong@gmail.com

Hong Anh said...

According to:
http://www.mayoclinic.org/tests-procedures/carotid-ultrasound/basics/why-its-done/prc-20012897

Doctor will recommend carotid ultrasound if you have transient ischemic attacks (TIAs) or certain types of stroke and may recommend a carotid ultrasound if you have medical conditions that increase the risk of stroke, including:

High blood pressure
Diabetes
High cholesterol
Family history of stroke or heart disease
Recent transient ischemic attack (TIA) or stroke
Abnormal sound in carotid arteries (bruit), detected by your doctor using a stethoscope
Coronary artery disease

Hong Anh said...

According to Mayoc Clinic: http://www.mayoclinic.org/tests-procedures/carotid-ultrasound/basics/why-its-done/prc-20012897

doctor will recommend carotid ultrasound if you have transient ischemic attacks (TIAs) or certain types of stroke and may recommend a carotid ultrasound if you have medical conditions that increase the risk of stroke, including:

High blood pressure
Diabetes
High cholesterol
Family history of stroke or heart disease
Recent transient ischemic attack (TIA) or stroke
Abnormal sound in carotid arteries (bruit), detected by your doctor using a stethoscope
Coronary artery disease