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The aim of this study was to investigate the dual-port effect in patients with internal carotid artery occlusion using intravascular ultrasound (IVUS) and transcranial Doppler (TCD). IVUS and TCD were performed in 18 patients with internal carotid artery occlusion. Anatomical imaging and blood velocity waveforms were recorded. In 10 patients, a flow diverter was placed in the ipsilateral common carotid artery to occlude the carotid bifurcation from the occluded internal carotid artery. Using IVUS, a two-layer plaque was observed at the carotid bifurcation in all patients. In 13 patients, high-velocity flow was detected at the carotid bifurcation in the ipsilateral middle cerebral artery during internal carotid artery occlusion. In six of these patients, the Doppler signal disappeared after carotid artery occlusion. This was attributed to a dual-port effect, in which two new vessel channels were formed at the carotid bifurcation. IVUS revealed a thickened two-layer plaque in carotid bifurcation (n = 10), a double lumen within the plaque (n = 7), and no flow behind the plaque (n = 5). However, no evidence of a dual-port effect was found in six patients with a double lumen. On IVUS, the Doppler signal disappeared in patients with a dual-port effect, whereas no change was observed in those without this effect. This study demonstrated that the dual-port effect may
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