Detection of Total Occlusion of the Internal Carotid Artery by Carotid Duplex Ultrasound in a Patient With Acute Hemispheric Ischemic Stroke

ABSTRACT Introduction Accurate identification of high‐grade stenosis or occlusion in the extracranial internal carotid artery (ICA) in patients experiencing acute stroke is essential, as carotid revascularization in cases of high‐grade stenosis amenable to surgical or endovascular intervention, and total ICA occlusion is managed with medical therapy. This is associated with a reduced risk of recurrent stroke in appropriately selected patients with symptomatic high‐grade stenosis. We present a case of a 78‐year‐old female who experienced a sudden onset of left‐sided hemiplegia. Methods Computerized tomography (CT) followed by magnetic resonance imaging (MRI)–diffusion weighted images (DWI) without contrast on the brain were performed. A carotid duplex (CD) was conducted around the same period using the GE VolusonE8 ultrasound machine equipped with the L9‐4 MHz transducer. Results A significant right cerebral hemispheric infarction was verified through head CT without contrast and MRI (DWI). A CD indicated complete occlusion of the right extracranial ICA. The medical team delivered appropriate treatment and management, and her subsequent recovery was smooth, but unfortunately, the patient eventually passed away. Conclusion This reported case emphasizes the importance of extracranial CD in detecting total occlusion of the extracranial ICA, with potential intracranial ICA involvement leading to extensive brain infarction. Further studies are needed to explore such relationships.