Basilar Apex Aneurysms in the Setting of Carotid Artery Stenosis: Case Series and Angiographic Anatomic Study

Background: Intracranial aneurysms (IAs) are life-threatening lesions known within the literature to be found incidentally during routine angiographic workup for carotid artery stenosis (CAS). As IAs are associated with vascular shear stress, it is reasonable to expect that altered flow demands within the anterior circulation, such as with CAS, increase compensatory flow demands via the Circle of Willis (COW) and may induce similar stress at the basilar apex. Objective: We present a series of nine unruptured basilar apex aneurysms (BAA) with CAS and a comparative radiographic analysis to BAA without CAS. Methods: Twenty-three patients with BAA were retrospectively identified using records from 2011 to 2016. CAS by North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria, morphology of BAA, competency of COW, and anatomic relationships within the posterior circulation were examined independently by a neuroradiologist using angiographic imaging. Results: Nine (39%) of the twenty-three BAA patients had CAS, with six having stenosis ≥50%. Four (67%) of the patients with ≥50% CAS demonstrated aneurysm flow angles contralateral to the side with highest CAS. Additionally, the angle between the basilar artery (BA) trajectory and aneurysm neck was observed to be smaller in patients with ≥50% CAS (61 vs 74 degrees). No significant differences in COW patency, posterior circulation morphology, and degree of stenosis were observed. Conclusion: Changes in the cervical carotid arteries may lead to blood flow alterations in the posterior circulation that increase the propensity for BAA formation. Posterior circulation imaging can be considered in CAS patients to screen for BAA.

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Mycophenolate mofetil attenuates plaque inflammation in patients with symptomatic carotid artery stenosis

Atherosclerosis ◽

10.1016/j.atherosclerosis.2010.01.043 ◽

2010 ◽

Vol 211 (1) ◽

pp. 231-236 ◽

Cited By ~ 41

Author(s):

Sander I. van Leuven ◽

Diederik F. van Wijk ◽

Oscar L. Volger ◽

Jean-Paul P.M. de Vries ◽

Chris M. van der Loos ◽

...

Keyword(s):

Mycophenolate Mofetil ◽

Carotid Artery ◽

Carotid Artery Stenosis ◽

Artery Stenosis ◽

Symptomatic Carotid ◽

Plaque Inflammation

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Immediate versus delayed treatment for recently symptomatic carotid artery stenosis

Cochrane Database of Systematic Reviews ◽

10.1002/14651858.cd011401.pub2 ◽

2016 ◽

Cited By ~ 1

Author(s):

Vladimir Vasconcelos ◽

Nicolle Cassola ◽

Edina MK da Silva ◽

Jose CC Baptista-Silva

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenosis ◽

Artery Stenosis ◽

Symptomatic Carotid ◽

Delayed Treatment

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Abstract 2509: Standardized Reports Are Needed To Describe Carotid Artery Stenosis

Stroke ◽

10.1161/str.43.suppl_1.a2509 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Eric Cheng ◽

Salomeh Keyhani ◽

Susan Ofner ◽

Linda Williams ◽

Dawn Bravata

Keyword(s):

Decision Making ◽

Clinical Trials ◽

Carotid Artery ◽

Carotid Artery Stenosis ◽

Diagnostic Tests ◽

Artery Stenosis ◽

Fiscal Year ◽

Symptomatic Carotid ◽

Imaging Results ◽

Exact Degree

Background: Landmark clinical trials have shown that carotid procedures can greatly reduce the risk of stroke in persons with symptomatic carotid artery stenosis between 70 and 99% and can somewhat reduce the risk of stroke in persons with symptomatic carotid stenosis between 50 and 69%. Guidelines have recommended that results from carotid artery imaging tests be presented in these ranges to facilitate decision-making. We sought to determine how carotid imaging results were reported across Veterans Administration (VA) facilities. Methods: Carotid artery imaging results were obtained as part of a comprehensive chart review of veterans hospitalized with ischemic stroke at 127 VA hospitals in fiscal year 2007. Abstractors recorded the results of carotid ultrasound, MR angiography, CT angiography, or catheter angiography performed in the twelve months prior to admission to six months after admission. We excluded carotid artery imaging reports with results of “no stenosis”, “mild stenosis”, exact degree of stenosis <50%, or any range of stenosis <50% to focus on those reports that would likely inform decisions about carotid procedures. The unit of analysis was the carotid artery. We described how often the results were presented as an exact degree (such as 60%), as a range (such as 50 to 69%), or as a descriptive category (“moderate” or “severe” stenosis). For results described as a range, we examined how often it matched those used in landmark trials. Results: Of 6527 results of carotid artery imaging, there were 1315 results of greater than 50% or at least “moderate stenosis” (see Table ). Only 234 of the reports used a range to describe the stenosis; among this set, only 55 of the reports used a 50-69% or 70-99% range to describe the stenosis. Conclusions: In this national healthcare system, significant carotid artery stenosis was rarely reported in a way that exactly mapped onto recommendations from landmark clinical trials and guidelines. Clinicians who order these diagnostic tests as well as clinicians who interpret these diagnostic tests should collaborate to produce standardized reports that facilitate decision-making.

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Significant changes of the choroid in patients with ocular ischemic syndrome and symptomatic carotid artery stenosis

PLoS ONE ◽

10.1371/journal.pone.0224210 ◽

2019 ◽

Vol 14 (10) ◽

pp. e0224210 ◽

Cited By ~ 2

Author(s):

Hae Min Kang ◽

Jeong Hoon Choi ◽

Hyoung Jun Koh ◽

Sung Chul Lee

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenosis ◽

Artery Stenosis ◽

Symptomatic Carotid ◽

Ocular Ischemic Syndrome ◽

Ischemic Syndrome

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Periprocedural Thromboembolic Events Associated with Angioplasty and Stenting of the Extra- and Intracranial Carotid Artery Assessed by Neurological Status and Diffusion-Weighted Magnetic Resonance Imaging (DWI)

ISRN Vascular Medicine ◽

10.5402/2012/984178 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7

Author(s):

Frank Ahlhelm ◽

Johanna Lieb ◽

Stefan Ulmer ◽

Dirk Ahlhelm ◽

Wolfgang Reith

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenosis ◽

Vessel Diameter ◽

Internal Carotid Artery Stenosis ◽

Artery Stenosis ◽

Thromboembolic Events ◽

Intracranial Stenting ◽

Symptomatic Carotid ◽

Diffusion Weighted ◽

Angioplasty And Stenting

Objective. The purpose of this study was to determine the frequency of thromboembolic events associated with angioplasty and stenting of the carotid artery with special regard to extra- or intracranial localization of stenosis. Methods. Twenty patients with symptomatic intracranial or extracranial internal carotid artery stenosis were treated with stenting and/or angioplasty. In 4 patients stenting was technically not feasible (all in the group with intracranial stenosis). All patients underwent diffusion-weighted imaging (DWI) and neurological examination within 48 hours before and after the procedure to detect periprocedural thrombembolic events. Results. Extracranial carotid angioplasty and stenting (eCAS) was technically feasible and successfull without procedure-related neurological complications in all cases. Intracranial stenting (iCAS) was not feasible in four cases including one patient with a fateful course. Concerning the restoration of the vessel diameter intracranial stenting was not as successful as eCAS, but more effective than balloon angioplasty alone. Incidence of thrombembolic events assessed by DWI was low. The detected periprocedural thrombembolic events were small and clinically silent. Conclusion. The risk of thromboembolic events during the endovascular treatment of symptomatic carotid artery stenosis was rather low for intra- and extracranial stenosis of the ICA in our patient sample, but one fatal course was observed.

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