Viable Brain with bilateral Internal Carotid Occlusion, A Case Report.

Bilateral internal carotid artery (ICA) occlusion is extremely rare. The risk of stroke in patients with total ICA occlusion is significant. Outcome in patients with symptomatic ICA occlusion has not substantially improved over the years. We report a case of bilateral carotid occlusion in a middle aged woman. She was a healthy woman that was presented with slight numbness in her right hand. Duplex Ultra-sonography demonstrated a homogenous plaque in origin of Right Internal Carotid Artery (RICA) that caused 90% stenosis, and total occlusion of Left Internal Carotid Artery (LICA). Cervical Magnetic Resonance Angiography (MRA) confirmed occlusion of LICA and 90% stenosis of RICA. Patient was referred for right sided Carotid End Arterectomty(CEA).Unexpectedly in follow up Digital Subtraction Angiography (DSA), one week after surgery; total occlusion of both ICAs was observed.. After 12 months of follow up; despite bilateral ICA occlusion, she is well, active, and productive with completely normal neurological examination.