Endovascular significance of the external carotid artery in the treatment of cerebrovascular insufficiency.

Purpose: To present illustrative cases that demonstrate the feasibility and clinical benefits of endovascular treatment of external carotid artery (ECA) stenoses in patients with occluded internal carotid arteries (ICA).

Case Reports: Three patients with symptoms of cerebrovascular insufficiency and a stenosis of the ECA in the presence of occluded ICAs and diseased vertebral arteries were treated successfully by percutaneous stent or stent-graft implantation with and without cerebral protection.

Conclusions: The ECAs play an important role in providing collateral blood supply to the brain through the many connections between branches of the ECA and cranial branches of the ICA and vertebral arteries. If these important pathways of collateral cerebral blood flow become diseased, ischemic symptoms become apparent. We recommend an endovascular procedure as a potential alternative to surgical endarterectomy of the ECA in patients with severe extracranial arterial disease.