CHRONIC TOTAL - OCCLUSIONS OF BOTH ICAS: A RARE CHALLENGE. A SUCCESSFUL REVASCULARISATION

Clinical Presentation

A patient presented with severe cognitive decline, aphasia, and bilateral limb weakness. Imaging revealed chronic total occlusion of both internal carotid arteries (ICAs). Despite medical management, the patient's neurological condition continued to deteriorate.

Treatment Planning

Given the progressive symptoms and compromised cerebral perfusion, bilateral ICA revascularisation was planned. A multidisciplinary neurovascular team carefully assessed the collateral circulation and procedural risks.

Procedure

Complete long-segment reconstruction of both ICAs was successfully performed to restore cerebral blood flow. The procedure was carried out by Dr. Rajeev Sivasankar, Director - Neurovascular Interventional Radiology, and his team at Fortis Hospital, Mulund.

Postoperative Outcome

The patient was closely monitored following the procedure, with strict blood pressure control and neurological observation to ensure adequate cerebral perfusion and prevent complications.

Results

Successful revascularisation resulted in improved cerebral blood flow and a favourable clinical outcome, with neurological recovery observed during follow-up.

Conclusion

Bilateral chronic ICA occlusion is a rare and complex cerebrovascular condition that can lead to severe neurological impairment when collateral circulation becomes inadequate. Successful bilateral revascularisation demonstrates the importance of advanced neurovascular intervention & specialised multidisciplinary care in appropriately selected patients.