ABSTRACT
This patient had an uneventful carotid endarterectomy. He was also known to have a contralateral carotid occlusion. In the immediate postoperative period (approximately 1 hour after surgery), the development of a left brachial paresis was noted and the decision was made to proceed immediately to arteriography, where complete occlusion of the carotid artery was demonstrated. It is to be noted in this lateral radiograph that there is a small stump at the site of the occluded ICA and also good retrograde flow by external to internal collaterals filling the cavernous and petrous portions of the carotid artery. This retrograde flow indicates a high likelihood of the ability to reopen the vessel at surgery. This patient was immediately returned to surgery where backbleeding was quickly established on reopening the carotid tree. The carotid artery was then reconstructed with a saphenous vein patch graft, and the patient made a gratifying return to normal neurologic function.
