Recanalisation of occluded internal carotid artery

There is controversy over the suggestion that recanalisation of extracranially occluded internal carotid arteries (ICAs) is more frequent than actually documented, A follow-up of thirty patients with sonographically (n = 31) and angiographically (n = 29) verified occlusion of the ICA was performed at median 401 days after occlusion. In 24 cases, the occlusion was due to arteriosclerosis and thrombosis; in three cases due to macroembolism; in three cases due to dissection and in one case due to exogenous trauma. 16 patients received an anticoagulant therapy with intravenous heparin (25 000 IE/d). In three patients with arteriosclerotic-thrombotic or embolic occlusion of the ICA partial or complete recanalisation was found 18 days, 37 days and 16 years respectively after the initial diagnosis. Two of them received high-dose intravenous heparin. Two patients with occlusions due to dissection showed nearly normalized recanalisation. They were treated with high-dose heparin, Our results show that recanalisation of an occluded carotid artery due to arteriosclerosis and thrombosis or macroembolism is possible but rare. Treatment with high-dose heparin does not lead to better recanalisation. Occlusion due to dissection shows a higher rate of recanalisation.