Internal carotid artery anatomy – not always straightforward

Vascular ◽  
2022 ◽  
pp. 170853812110697
Author(s):  
Maroš Rudnay ◽  
Gabriela Rjašková ◽  
Viera Lehotská
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Ct Angiography ◽  
Carotid Arteries ◽  
Internal Carotid ◽  
Incidental Finding ◽  
Clinical Importance ◽  
External Carotid ◽  
Occipital Artery ◽  
Cervical Portion

Objectives To present a rare variant of internal carotid artery anatomy. Methods Case report presenting CT angiography finding of internal carotid anatomy variant. Results We present the case of an unusual origin of the occipital artery from cervical portion of the internal carotid artery as an incidental finding during CT angiography of the carotid arteries. In discussion, we discuss the possible embryological basis, incidence and prevalence of such finding and its possible clinical implications. Conclusion One of the specific aspects of carotid arteries is their straightforward anatomy – the cervical portion of internal carotid artery, unlike the external carotid, does not give origin to any branches – this aspect is even used as a highlight for orientation, e.g. during ultrasound examination. However, although rare, variants exist, and sometimes can have clinical importance – in the endovascular access or surgical treatment.

Carotid Duplex Velocity Criteria Revisited for the Diagnosis of Carotid In-Stent Restenosis

Vascular ◽  
2007 ◽  
Vol 15 (3) ◽  
pp. 119-125 ◽  
Author(s):  
Ali F. AbuRahma ◽  
Damian Maxwell ◽  
Kris Eads ◽  
Sarah K. Flaherty ◽  
Tabitha Stutler
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Ct Angiography ◽  
Carotid Arteries ◽  
Internal Carotid ◽  
Carotid Angiography ◽  
Residual Stenosis ◽  
Stent Restenosis ◽  
The Mean ◽  
In Stent Restenosis

Carotid percutaneous transluminal angioplasty/stenting has become an accepted treatment modality for carotid artery stenosis in high-risk patients. There has been an ongoing debate regarding which duplex ultrasound (DUS) criteria to use to determine the rate of in-stent restenosis. This prospective study revisits DUS criteria for determining the rate of in-stent restenosis. In analyzing a subset of 12 patients (pilot study) who had both completion carotid angiography and DUS within 30 days, 10 patients with normal post-stenting carotid angiography (< 30% residual stenosis) had peak systolic velocities (PSVs) of the stented internal carotid artery (ICA) of ≤ 155 cm/s and two patients with ≥ 30% residual stenosis had internal carotid artery (ICA) PSVs of > 155 cm/s. Eighty-three patients who underwent carotid stenting as part of clinical trials were analyzed. All patients underwent post-stenting carotid DUS that was done at 1 month and every 6 months thereafter. PSVs and end-diastolic velocities of the ICA and common carotid artery were recorded. Patients with PSVs of the ICA of > 140 cm/s underwent carotid computed tomographic (CT) angiography. The perioperative stroke rate was 1.2%. When the old DUS velocity criteria for nonstented carotid arteries were applied, 54% of patients had ≥ 30% restenosis (PSV of > 120 cm/s), but when our new proposed DUS velocity criteria for stented arteries were applied (PSV of > 155 cm/s), 33% had ≥ 30% restenosis at a mean follow-up of 18 months ( p = .007). The mean PSVs for patients with normal stented carotid arteries based on CT angiography, were 122 cm/s versus 243 cm/s for ≥ 30% restenosis and 113 cm/s versus 230 cm/s for ≥ 30% restenosis based on our new criteria. The mean PSVs of in-stent restenosis of 30 to < 50%, 50 to < 70%, and 70 to 99%, based on CT angiography, were 205 cm/s, 264 cm/s, and 435 cm/s, respectively. Receiver operating curve analysis demonstrated that an ICA PSV of > 155 cm/s was optimal for detecting ≥ 30% in-stent restenosis, with a sensitivity of 100%, a specificity of 90%, a positive predictive value of 74%, and a negative predictive value of 100%. The currently used carotid DUS velocity criteria overestimated the incidence of in-stent restenosis. We propose new velocity criteria for the ICA PSV of > 155 cm/s to define ≥ 30% in-stent restenosis.

scholarly journals Carotid artery stenting for patients with occipital–vertebral anastomosis

2018 ◽  
Vol 25 (2) ◽  
pp. 212-218
Author(s):  
Ryuichiro Kajikawa ◽  
Toshiyuki Fujinaka ◽  
Hajime Nakamura ◽  
Manabu Kinoshita ◽  
Takeo Nishida ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Vertebral Artery ◽  
High Intensity ◽  
Carotid Artery Stenting ◽  
Internal Carotid ◽  
External Carotid ◽  
Occipital Artery ◽  
Protection Method ◽  
Distal Internal Carotid Artery

Background and purpose We report the outcomes of carotid artery stenting for patients with angiographically visible occipital artery–vertebral artery anastomosis. Methods Among 47 consecutive patients who underwent carotid artery stenting from January 2007 to December 2010, seven patients for whom cerebral angiograms clearly showed occipital artery–vertebral artery anastomosis were selected. Four different protection methods were used: distal internal carotid artery protection; carotid flow reversal; seatbelt and airbag technique; and double protection method of protecting both the external and internal carotid artery. Results One patient with distal internal carotid artery protection showed a high-intensity lesion at the border of the upper thalamus, internal capsule and lateral ventricle wall after carotid artery stenting. The other patient with the double protection method did not show any high-intensity lesions on postoperative diffusion-weighted imaging in the vertebrobasilar territory. All seven patients with visible occipital artery–vertebral artery anastomosis showed ipsilateral vertebral artery severe stenosis or occlusion. Conclusion Large occipital artery–vertebral artery anastomosis may be a pathway for embolic materials during carotid artery stenting. External carotid artery protection is recommended for carotid artery stenting in such patients.

scholarly journals Unusual position of external carotid artery: a case report

2005 ◽  
Vol 38 (02) ◽  
pp. 170-171
Author(s):  
S B Rao ◽  
V R Vollala ◽  
M Rao ◽  
V P Samuel ◽  
D Deepthinath ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Arteries ◽  
Internal Carotid ◽  
Clinical Importance ◽  
Lateral Position ◽  
External Carotid Artery ◽  
External Carotid ◽  
Unusual Position ◽  
The Common ◽  
Internal Carotid Arteries

AbstractThe arterial pattern of the human body is one of the systems that show a large number of variations. Many reports are available regarding variations of common carotid, external and internal carotid arteries and branches of external carotid artery. We describe a very rare case of lateral position of external carotid artery. The external carotid artery was lateral to the internal carotid artery at the bifurcation of the common carotid artery. The clinical importance of this variation is discussed.

scholarly journals Stenting in the Remnant of the Third Aortic Arch in a Case of Post-Irradiation Occluded Internal Carotid Artery

2011 ◽  
Vol 17 (1) ◽  
pp. 22-26
Author(s):  
H.-C. Chen ◽  
C.-J. Lin ◽  
F.-C. Chang ◽  
C.-B. Luo ◽  
Y.-J. Lai ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Arteries ◽  
Internal Carotid ◽  
Transluminal Angioplasty ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
External Carotid ◽  
First Case ◽  
Internal Carotid Arteries

Collateral networks between the external carotid artery and internal carotid arteries become crucial for cerebral perfusion after occlusion of internal carotid arteries. We report the first case of a patient who received percutaneous transluminal angioplasty and stenting in a collateral vessel between the external and internal carotid artery for treatment of radiation induced severe stenosis of the internal carotid artery in the context of a contralateral internal carotid artery occlusion.

Agenesis of the cervical internal carotid artery

1989 ◽  
Vol 103 (7) ◽  
pp. 707-709 ◽  
Author(s):  
T. Nishimura ◽  
T. Takimoto ◽  
M. Kamide ◽  
S. Ishikawa ◽  
R. Umeda
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Radical Surgery ◽  
Vascular Anomaly ◽  
External Carotid Artery ◽  
External Carotid ◽  
Digital Subtraction ◽  
Cervical Portion ◽  
The Right

AbstractTotal or segmental agenesis of the internal carotid artery is a rare anomaly. The cervical portion of the internal carotid artery was absent in the right side of the patient who was carried out radical surgery due to recurrent oropharyngeal cancer. Post-operative venous digital subtraction angiography revealed that the remaining intracranial portion of the internal carotid artery was normally patent and supplied blood flow via ipsilateral external carotid artery. Otolaryngologist-Head and Neck surgeon should know such a vascular anomaly and avoid a disastrous result on dividing external carotid artery.

External Carotid Occlusion as a Cause of Recurrent Ischemia after Carotid Endarterectomy

Neurosurgery ◽  
1982 ◽  
Vol 11 (4) ◽  
pp. 518-521 ◽  
Author(s):  
Roger W. Countee ◽  
Thurairasah Vijayanathan ◽  
Shu Z. Wu
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Arteries ◽  
Internal Carotid ◽  
External Carotid Artery ◽  
External Carotid ◽  
Complete Relief ◽  
Avoidable Complication ◽  
Common Carotid Arteries

Abstract Our experiences with a patient who developed recurrent hemispheric transient ischemic attacks 3 1/2 years after ipsilateral carotid endarterectomy are described. Although repeat arteriography demonstrated smooth and unobstructed common and internal carotid arteries and a normal intracranial circulation, there was complete occlusion of the external carotid artery at its origin, which appeared as a stump or diverticulum at the origin of the internal carotid artery. This stump was filled with atherothrombotic debris and served as a source of emboli to the adjacent and patent internal carotid artery. Excision of the stump effected complete relief of the recurrent ischemic symptoms. The pernicious potential of an external carotid obstruction when adjacent to a patent internal carotid artery should be recognized. To prevent this avoidable complication of carotid endarterectomy, we recommend that the origin of the external carotid artery be treated with the same standards of technical perfection as those customarily applied to the internal and common carotid arteries during this procedure.

scholarly journals Bilateral Agenesis of Internal carotid artery: A case report with emphasis on neuroimaging features

2017 ◽  
Vol 2 (1) ◽  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Incidental Finding ◽  
Anatomic Variation ◽  
Color Doppler ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Congenital Absence ◽  
External Carotid

Congenital absence of the internal carotid artery is a rare anomaly, occurring in less than 0.01% of the population [1, 3]. It includes agenesis, aplasia, and hypoplasia of the internal carotid artery [2, 5]. Recognition of these anomalies has important implications during planned surgery, in thromboembolic disease and in the surveillance and detection of associated cerebral aneurysms [2, 3]. It is usually an incidental finding on color Doppler carotid ultra sonography, angiography, computed tomography or magnetic resonance imaging of the head and neck taken for some other indication [2, 6]. Most of the patients are asymptomatic due to the presence of sufficient cerebral circulation supplied by the communicating arteries of the circle of Willis, inter cavernous anastomosis, external carotid artery and by persistent embryologic arteries to the carotid artery territory. Nevertheless, in some cases this anatomic variation may eventually lead to some clinical signs and symptoms [2, 4, 6]. We present a rare case of congenital absence of both internal carotid arteries and its possible implications.

Stump embolization from an occluded internal carotid artery

1987 ◽  
Vol 67 (4) ◽  
pp. 609-611 ◽  
Author(s):  
Patrick G. Ryan ◽  
Arthur L. Day
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Arteries ◽  
Internal Carotid ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
External Carotid ◽  
Transient Ischemic Attacks ◽  
Content Type ◽  
Fine Print

✓ A patient with known internal carotid artery occlusion developed transient ischemic attacks in the distribution of the occluded vessel. Arteriography demonstrated a thrombus clearly originating from the internal carotid artery stump, which was unassociated with significantly stenotic atherosclerotic disease of the ipsilateral common or external carotid arteries. Stump angioplasty and endarterectomy led to complete and sustained cessation of further symptoms.

scholarly journals Congenital absence of internal carotid artery with intercavernous anastomosis: Case report and systematic review of the literature

2016 ◽  
Vol 22 (4) ◽  
pp. 473-480 ◽  
Author(s):  
Ibrahim Ilker Oz ◽  
Ismail Serifoglu ◽  
Omer Yazgan ◽  
Zuhal Erdem
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Collateral Circulation ◽  
Carotid Arteries ◽  
Internal Carotid ◽  
External Carotid Artery ◽  
External Carotid ◽  
Review Of The Literature ◽  
Rare Congenital Anomaly ◽  
Internal Carotid Arteries

The absence of an internal carotid artery is a rare congenital anomaly. In the absence of the internal carotid artery, collateral circulations develop through the circle of Willis, persistent embryonic arteries or transcranial collaterals of the external carotid artery. Six pathways of collateral circulation have been described. Intercavernous anastomosis is between cavernous segments of the bilateral internal carotid arteries and is rarely seen. Patients with an absence of the internal carotid artery can be completely asymptomatic. However, these patients can present with subarachnoid hemorrhage or stroke accompanying cerebral aneurysm or abnormal collateral. We combined our case with 33 previous publications to form a retrospective series including 35 cases of unilateral internal carotid artery agenesis with intercavernous anastomosis.

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