title: Cough-induced transient ischemic attack treated with revascularization of the external carotid artery.
abstract: A 65-year-old man presented with right arm and face weakness associated with severe coughing fits. A computed tomography angiogram revealed an occlusion of the left common and internal carotid arteries and an incomplete circle of Willis. An arch angiogram demonstrated reconstitution of the left external carotid artery, which collateralized with the intracranial left internal carotid artery. The patient underwent left subclavian-to-external carotid artery bypass with reversed saphenous vein, with complete resolution of symptoms over 1 year of follow-up. Cough-induced hemispheric transient ischemic attack is a rarely described hemodynamic phenomenon that can be managed with revascularization of the external carotid artery in select patients.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Dallas Veterans Affairs Medical Center, Dallas, Tex; Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Tex. Electronic address: shirling.tsai@utsouthwestern.edu.
authors.forename: Shirling
authors.initials: S
authors.lastname: Tsai
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Dallas Veterans Affairs Medical Center, Dallas, Tex; Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Tex.
authors.forename: M Shadman
authors.initials: MS
authors.lastname: Baig
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Dallas Veterans Affairs Medical Center, Dallas, Tex; Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Tex.
authors.forename: Fatima
authors.initials: F
authors.lastname: Abrantes-Pais
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Tex.
authors.forename: R James
authors.initials: RJ
authors.lastname: Valentine
mesh_terms: D000368:Aged; D002342:Carotid Artery, External / Q000503:physiopathology / Q000601:surgery*; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D002533:Cerebral Angiography / Q000379:methods; D003097:Collateral Circulation; D003371:Cough / Q000150:complications*; D006439:Hemodynamics; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D012501:Saphenous Vein / Q000637:transplantation*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D058017:Vascular Grafting