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Posted by Dr Elliot Shevel ( on January 18, 2001 at 13:10:15:

In Reply to: Clusters posted by Dr Elliot Shevel on January 18, 2001 at 12:28:51:

I received a private e-mail query from one of your members requesting further info. This was my reply -

The procedure where a catheter is inserted into the carotid artery via an
incision in the groin is called a "carotid angiogram". It is commonly used
for the purpose of injecting radio-opaque dye into the carotid artery, so
that the branches of the carotid can be x-rayed.

In trauma cases, where there is uncontrolled bleeding from for instance, the
internal maxillary artery, which is difficult to access surgically, a
carotid angiogram is carried out, and a coil is released into the artery
just before the part which has been traumatised. This blocks the artery and
stops the bleed. There is no danger in blocking the artery, as there is a
wonderful collateral blood supply in the head and neck region.

Any radiologist will be able to confirm that it is a well-known procedure.

It has not, to my knowledge been used before in the treatment of cluster

If one is certain that the origin of the vascular pain in your cluster is
from the internal maxillary artery, then blocking the artery will do the

It is unfortunately not that simple, however, as other branches of the
external carotid artery may be involved, and they all have to be blocked or
ligated to get a good result. To diagnose which branches are involved would
mean that the patient must be seen by someone with the necessary experience
of the procedure, while there was a cluster present.

A relatively simple way of determining whether the surgery is likely to be
successful is to compress the carotid artery on the side of the pain. If
this results in immediate pain relief, then the next step would be to
determine which branches of the external carotid are involved.

Get someone to show you how to compress the carotid artery - its not
difficult if you know where to press. If it makes you feel a little dizzy or
faint, release the pressure.

Comments and questions are welcome!

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