I have a neat study to write about. I am doing a carotid study on a 60 year old patient with confusion as the indicator. She is obese with a very thick neck (we all know what i am talking about). I get retrograde flow in the right CCA, ECA and VERT. I also get a monophasic signal in the right subclavian artery. The right ICA appears occludded by doppler and color. So I am thinking a brachialcephalic stenosis or a occlusion at this point. I go to the left side. The CCA is going antagrade with 1-39 stenosis in the ICA. My vertebral signal is retrograde and the subclavian signal is monophasic.
The angoi Doc could not get access from the right groin so he went to the left groin and just when he was about to give up, he gets into the aorta which was occluded. Well to cut to the chase the brachialcephalic was occluded with a high grade stenosis of the left subclavian. He stents the left subclavian changing the left vert to antagrade flow. He confirms the retrograde flow in the right vert and CCA. Then ask me to repeat my study. To my very surprise I find now retorgrade flow in the right ECA, CCA, vert and ICA which appeared occluded yesterday. I tell my angio doc and he takes another look at his angio and he confirms this finding. Now has anyone heard or seen of retrograde flow in the ICA in an adult.
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