Bilateral carotid vertebrobasilar rete mirabile

✓ Nineteen patients underwent a total of 21 stump angioplasty procedures for an occluded internal carotid artery. Indications for surgery included the preparation of the donor vessel for a subsequent extracranial-intracranial bypass procedure, the occurrence of emboli to the intracranial vasculature from the external carotid artery circulation, and the association with symptomatic occlusive disease of the external carotid artery accompanying occlusion of the ipsilateral internal carotid artery. The technique utilized and the results obtained in these 19 patients are presented. In select patients, the removal of an occluded internal carotid artery stump via a stump angioplasty is beneficial in preventing the catastrophic sequela of embolic cerebrovascular disease.

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Hemodynamically significant stenosis of the internal carotid artery treated with endarterectomy

Journal of Neurosurgery ◽

10.3171/jns.1984.60.5.1070 ◽

1984 ◽

Vol 60 (5) ◽

pp. 1070-1075 ◽

Cited By ~ 29

Author(s):

Sissel Vorstrup ◽

Hans Christian Engell ◽

Helle Lindewald ◽

Niels Alexander Lassen

Keyword(s):

Blood Pressure ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Photon Emission ◽

Minor Stroke ◽

External Carotid ◽

Content Type ◽

Arterial Blood ◽

Fine Print

✓ Repeated cerebral blood flow (CBF) measurements with xenon-133 inhalation and single photon emission tomography were performed in a patient suffering a minor stroke with subsequent orthostatic-provoked transient ischemic attacks (TIA's). Angiography revealed a thread-like internal carotid artery and an occluded external carotid artery on the side of the ischemic neurological symptoms. Computerized tomography and technetium-99m-pertechnetate brain scintigraphy 2 weeks after stroke were both normal. Before reconstructive vascular surgery, resting CBF showed a hypoperfused area corresponding to the clinical symptoms. Diamox (acetazolamide, 1 gm) increased CBF by 24% in the unaffected hemisphere, whereas even a slight decrease in flow (“steal”) was seen in the maximally affected region. In contrast, theophylline (220 mg) reduced CBF in the unaffected hemisphere and caused a slight increase in the previously maximally hypoperfused area (“inverse steal”). After surgery, the flow pattern practically normalized and the TIA's disappeared. The CBF measurements before surgery and also after the injection of the vasoactive drugs indicated that focal hemodynamic insufficiency elicited the TIA's, and pointed at a low mean arterial blood pressure of about 35 mm Hg in the affected hemisphere. The perioperative finding of a mean blood pressure in the internal carotid artery of 31 mm Hg on the symptomatic side confirmed that the brain tissue had a severely reduced perfusion pressure. On clamping the artery, a stump pressure of 22 mm Hg and electroencephalogram flattening was noted, so a temporary internal shunt was inserted. The findings demonstrate that preoperative CBF measurements, including studies of the regional vasoreactivity, may identify patients with hemodynamic TIA's. These patients are at particular risk of developing cerebral ischemia during carotid endarterectomy, as any further compromise of the inflow may precipitate frank ischemia.

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Stump embolization from an occluded internal carotid artery

Journal of Neurosurgery ◽

10.3171/jns.1987.67.4.0609 ◽

1987 ◽

Vol 67 (4) ◽

pp. 609-611 ◽

Cited By ~ 3

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.

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Rete mirabile of the ICA: Report of three cases

Interventional Neuroradiology ◽

10.1177/1591019918772054 ◽

2018 ◽

Vol 24 (5) ◽

pp. 586-590 ◽

Cited By ~ 2

Author(s):

Abha Verma ◽

Hima Pendharkar ◽

Chandrajit Prasad

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Normal Development ◽

Rare Entity ◽

Rete Mirabile ◽

Carotid Rete Mirabile ◽

Collateral Pathway ◽

Intracranial Circulation

Carotid rete mirabile is an arterial meshwork, occurring at the cavernous portion of the internal carotid artery (ICA). Rete mirabile in humans is not present during normal development of the intracranial circulation and hence is considered as a collateral pathway that develops as a consequence of segmental agenesis of the ICA. We report three cases of this rare entity encountered at our institute.

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The anomaly of a non-bifurcating cervical carotid artery

Journal of Neurosurgery ◽

10.3171/jns.1990.72.1.0130 ◽

1990 ◽

Vol 72 (1) ◽

pp. 130-132 ◽

Cited By ~ 29

Author(s):

Tadashi Morimoto ◽

Kazumi Nitta ◽

Kiyoshi Kazekawa ◽

Keizo Hashizume

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

External Carotid Artery ◽

Developmental Anomaly ◽

External Carotid ◽

Content Type ◽

Fine Print

✓ A case of a rare developmental anomaly of the cervical carotid artery is reported. In this patient the non-bifurcating carotid artery gave origin to all of the branches normally supplied by the external carotid artery and thereafter continued as the internal carotid artery. Embryological events responsible for this anomaly are briefly discussed.

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Thromboendarterectomy of the symptomatic occluded internal carotid artery

Journal of Neurosurgery ◽

10.3171/jns.1992.76.5.0752 ◽

1992 ◽

Vol 76 (5) ◽

pp. 752-758 ◽

Cited By ~ 52

Author(s):

Patrick W. McCormick ◽

Robert F. Spetzler ◽

Julian E. Bailes ◽

Joseph M. Zabramski ◽

James L. Frey

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

External Carotid ◽

Vertebrobasilar Insufficiency ◽

Surgical Morbidity ◽

Content Type ◽

The Impact ◽

Fine Print

✓ A retrospective review of 42 patients (mean age 61.4 years) with surgically managed symptomatic internal carotid artery occlusion is reported. A standardized surgical protocol aimed at restoration of flow in the vessel was used. Presenting symptoms included hemispheric transient ischemic attacks in 68% of patients, new fixed neurological deficits in 28%, amaurosis fugax in 28%, and stroke-in-evolution in 9%. Twenty-four arteries were successfully reopened. A proximal remnant angioplasty (stumpectomy) was performed alone in nine patients or in combination with an external carotid endarterectomy in nine. In four patients with persisting symptoms who failed to achieve primary restoration of flow, a superficial temporal-to-middle cerebral artery bypass procedure was performed. The permanent surgical morbidity rate was 2% and the surgical mortality rate was 0%. Transient postoperative deficits were present in three patients (7%). Follow-up review at a mean of 40 months was obtained in 39 patients (93%). Following surgical intervention, five patients died of unrelated causes, two had neurological events consistent with a transient cerebral ischemic attack, and two had vertebrobasilar insufficiency. No patient suffered from stroke. Of the 24 successfully reopened vessels, follow-up ultrasound evaluations were obtained in 17 (73%) at a mean of 28 months after surgery. In 15 patients (88%) the vessels were widely patent, one (5.8%) had stenosis greater than 70%, and one (5.8%) showed asymptomatic reocclusion. Reopening occluded internal carotid arteries in selected patients is associated with low surgical morbidity and mortality rates. Further studies are necessary to determine the impact of this surgical therapy on the natural history of this condition.

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Enlarged anterior spinal artery as collateral circulation

Journal of Neurosurgery ◽

10.3171/jns.1974.41.3.0356 ◽

1974 ◽

Vol 41 (3) ◽

pp. 356-359 ◽

Cited By ~ 6

Author(s):

Jun Karasawa ◽

Haruhiko Kikuchi ◽

Seiji Furuse ◽

Toshisuke Sakaki ◽

Yasumasa Makita

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Collateral Circulation ◽

Internal Carotid ◽

Vascular Malformations ◽

Anterior Spinal Artery ◽

Left Internal Carotid Artery ◽

Content Type ◽

Vertebral Arteries ◽

Fine Print

✓The authors report and discuss two cases in which collateral circulation could be angiographically demonstrated passing through the anterior spinal artery. Case 1 proved to have occlusions of the left internal carotid artery and both vertebral arteries. The basilar artery was visualized via the anterior spinal, the primitive trigeminal, and primitive otic arteries. The presence of multiple vascular malformations and an abnormal anterior spinal artery suggested that the latter had been functioning as collateral circulation since an embryonic stage. In Case 2, both internal carotids and both vertebral arteries were occluded by arteriosclerotic changes. It was assumed that the deleted anterior spinal artery visualized angiographically had developed into a collateral circulation with increasing age.

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Patient presentation, angiographic features, and treatment of strangulation-induced dissection of the internal carotid artery

Journal of Neurosurgery ◽

10.3171/jns.2000.92.3.0481 ◽

2000 ◽

Vol 92 (3) ◽

pp. 481-487 ◽

Cited By ~ 62

Author(s):

Adel M. Malek ◽

Randall T. Higashida ◽

Van V. Halbach ◽

Christopher F. Dowd ◽

Constantine C. Phatouros ◽

...

Keyword(s):

Domestic Violence ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Stent Placement ◽

Internal Carotid ◽

Artery Dissection ◽

Percutaneous Angioplasty ◽

Consistent Finding ◽

Content Type ◽

Fine Print

✓ Domestic violence leading to strangulation by an abusive spouse can cause carotid artery dissection. This phenomenon is rare and has been described in only three previous instances. The authors present their management strategies in three additional cases.Three young women aged 24 to 43 years were victims of manual strangulation committed by their spouses 3 months to 1 year before presentation. Two of the patients suffered delayed cerebral infarctions before presentation and angiography demonstrated focal, mirror-image severe residual stenoses in the high-cervical internal carotid artery (ICA), which were characteristic of a healed chronic dissection; there was no evidence of fibromuscular dysplasia. One of these patients underwent unilateral percutaneous angioplasty with stent placement, and the other underwent bilateral percutaneous angioplasty. Both patients have recovered from their strokes and remain clinically stable at 8 and 20 months posttreatment, respectively. The third patient presented with bilateral ischemic frontal watershed infarctions resulting from an occluded left ICA and a severely narrowed right ICA. Given the extent of the established infarctions, this case was managed with a long-term regimen of anticoagulation medications, and the patient remains neurologically impaired.These cases illustrate the susceptibility of the manually compressed ICA to traumatic injury as a result of domestic violence. They identify bilateral symmetrical ICA dissection as a consistent finding and the real danger of delayed stroke as a consequence of strangulation. Endovascular therapy in which percutaneous angioplasty and/or stent placement are used can be useful in treating residual focal stenoses to improve cerebral perfusion and to lower the risk of embolic or ischemic stroke.

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Carotid paraclinoid aneurysms with intradural origin and intracavernous location

Journal of Neurosurgery ◽

10.3171/jns.1978.48.4.0526 ◽

1978 ◽

Vol 48 (4) ◽

pp. 526-533 ◽

Cited By ~ 90

Author(s):

Stephen Nutik

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Precise Definition ◽

Separate Entity ◽

Content Type ◽

Paraclinoid Aneurysms ◽

Planning Treatment ◽

Definition Of ◽

Fine Print

✓ Five cases of a congenital berry aneurysm of the internal carotid artery with origin partially intradural and fundus mainly intracavernous are presented. Angiography does not allow a precise definition of the amount of aneurysm that is intradural, a fact of importance when planning treatment of these cases. However, the angiographic features are characteristic of the type and suggest that these aneurysms be grouped together as a separate entity.

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External carotid-cavernous fistula treated by arterial embolization

Journal of Neurosurgery ◽

10.3171/jns.1974.40.1.0110 ◽

1974 ◽

Vol 40 (1) ◽

pp. 110-114 ◽

Cited By ~ 20

Author(s):

M. Stephen Mahalley ◽

Stephan C. Boone

Keyword(s):

Carotid Artery ◽

Successful Treatment ◽

Arterial Embolization ◽

External Carotid Artery ◽

External Carotid ◽

Carotid Cavernous Fistula ◽

Content Type ◽

Cavernous Fistula ◽

Unusual Occurrence ◽

Fine Print

✓ The unusual occurrence of a carotid-cavernous fistula supplied entirely by branches of the external carotid artery is presented, and its successful treatment by arterial embolization described.

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