Carotid Near-Occlusion: A Comprehensive Review, Part 2--Prognosis and Treatment, Pathophysiology, Confusions, and Areas for Improvement

Abstract

In Part 1 of this review, the definition, terminology, and diagnosis of carotid near-occlusion were presented. Carotid near-occlusions (all types) showed a lower risk of stroke than other severe stenoses. However, emerging evidence suggests that the near-occlusion prognosis with full collapse (higher risk) differs from that without full collapse (lower risk). This systematic review presents what is known about carotid near-occlusion. In this second part, the foci are prognosis and treatment, pathophysiology, the current confusion about near-occlusion, and areas in need of future improvement.

Fig 1.

Comparison of bony carotid canals with ICA hypoplasia and near-occlusion. A, A case of right ICA hypoplasia. A narrow bony carotid canal (white arrow)—smaller than that on the contralateral side. Reprinted with permission from Ibrahim et al. B, A case of left near-occlusion with full collapse. The narrow left ICA (black arrow) is in a normal-sized bone channel—“a small brook in a large river bed.” Bone channels are similar on the left (black arrow) and right (black arrowhead).