Bilateral occlusion of the internal carotid artery and occlusion of the left vertebral artery - A case report

A rare case of an asymptomatic patient with occlusion of both internal carotid arteries (a. carotis interna, ACI) and the left vertebral artery (a. vertebralis, AV) verified by ultrasound and angiography is described. Collateral circulation in the patient was regulated by the vertebrobasilar system (right vertebral artery) and external carotid arteries (a. carotis externa, ACE) anastomoses to the ophthalmic artery. Neuroimaging analysis (computed tomography and magnetic resonance imaging) of the brain revealed the presence of "silent" ischemic lesions in both cerebral hemispheres. Due to the high perioperative risk in the patient without any signs of neurologic deficit, operative treatment was not indicated. Conservative drug therapy was recommended.