Persistent proatlantal artery with carotid-vertebral anastomosis

1975 ◽  
Vol 43 (4) ◽  
pp. 499-501 ◽  
Author(s):  
T. Surya Rao ◽  
Prahlad K. Sethi

✓ The authors describe the occurrence of proatlantal artery as an incidental angiographic observation in a young Indian soldier. This primitive anastomotic channel is seen extending from near the origin of the external carotid artery to the suboccipital region, traversing the foramen magnum and coursing beyond like a vertebral artery. The developmental and roentgenological aspects of carotid-basilar and carotid-vertebral anastomosis are discussed, along with a review of four similar cases reported previously.

1974 ◽  
Vol 40 (1) ◽  
pp. 110-114 ◽  
Author(s):  
M. Stephen Mahalley ◽  
Stephan C. Boone

✓ 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.


1974 ◽  
Vol 41 (4) ◽  
pp. 502-507 ◽  
Author(s):  
Carl J. Graf ◽  
Arnold H. Menezes

✓ The authors report a case in which the blood supply of a posterior fossa arteriovenous malformation was derived entirely from the external carotid artery.


1974 ◽  
Vol 41 (6) ◽  
pp. 681-687 ◽  
Author(s):  
Raymond E. Dahl ◽  
David G. Kline

✓ Arteriovenous malformations located within cerebral parenchyma are usually supplied by intracranial vessels. An extracranial blood supply to these lesions is rare. The authors report their experience with two such cases and discuss the 21 comparable reports.


1980 ◽  
Vol 53 (6) ◽  
pp. 849-850 ◽  
Author(s):  
Robert F. Spetzler ◽  
Michael Modic ◽  
Charles Bonstelle

✓ A patient undergoing external carotid artery therapeutic embolization for obliteration of a dural arteriovenous malformation suddenly developed a large occipital artery to vertebral artery shunt. A devastating stroke was averted because the appearance of the shunt was observed by fluoroscopy, the embolization was stopped, and the shunt verified on a subsequent angiogram. The risk of external carotid artery embolization without constant fluoroscopic control is emphasized.


1983 ◽  
Vol 58 (1) ◽  
pp. 139-140 ◽  
Author(s):  
Jesús Vaquero ◽  
Rafael G. de Sola ◽  
Roberto Martínez

✓ A case of lateral sinus pericranii in a 49-year-old woman is presented. These extraordinarily rare lesions should be considered in the differential diagnosis of epicranial tumors. The lack of filling on external carotid artery angiograms may lead to the error of dismissing the possibility of a vascularized lesion.


1986 ◽  
Vol 65 (4) ◽  
pp. 461-464 ◽  
Author(s):  
Edward C. Benzel ◽  
Kevin M. Sittig ◽  
Mansour Mirfakhraee

✓ 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.


1984 ◽  
Vol 60 (3) ◽  
pp. 506-511 ◽  
Author(s):  
Evelyn Teasdale ◽  
James Patterson ◽  
Douglas McLellan ◽  
Peter Macpherson

✓ Over a 2-year period the authors have studied the effects of preoperative subselective embolization of meningiomas. Thirty-six consecutive patients shown by computerized tomography (CT) to have a meningioma underwent selective internal and external carotid artery angiography, and any significant external carotid artery feeders were embolized (27 cases). It was found that CT and dynamic radioisotope scan findings were unable to predict the degree of vascularity of the tumor or its suitability for embolization. Furthermore, these tests, repeated after embolization, were unreliable in detecting either the extent of necrosis or reduction in blood flow. The effects of embolization upon surgery were recorded, and the excised tumor specimen examined for evidence of thrombosis and infarction. Subselective embolization was determined to be a simple, safe, and effective method of producing tumor necrosis and intraoperative hemostasis in selected patients.


1981 ◽  
Vol 55 (4) ◽  
pp. 532-542 ◽  
Author(s):  
Roger W. Countee ◽  
Thurairasah Vijayanathan ◽  
Pamela Chavis

✓ Seventeen patients with persistent amaurosis fugax ipsilateral to angiographically documented internal carotid artery (ICA) occlusions in the neck have been treated by the authors over the past 5 years. Complete cerebral arteriography in each case demonstrated that the symptomatic ophthalmic artery was perfused exclusively by the ipsilateral external carotid artery (ECA), which invariably had an obstructive and/or ulcerative lesion at its origin, and/or an adjacent residual “stump” of the occluded ICA. In nine patients, retinal artery branch emboli were visible on funduscopy. One patient had angiographic evidence of intracranial embolization via the ophthalmic artery from the ECA. Although ipsilateral superficial temporal-middle cerebral artery anastomosis in one patient, and endarterectomy of a contralateral carotid stenosis in another patient, failed to relieve symptoms, endarterectomy of the ECA with resection of the “stump” of the occluded ICA effectively terminated symptoms in 10 of 11 patients. Anticoagulant drug therapy promptly abolished symptoms in four nonsurgical patients as well as in two patients with failed operations. It is concluded that recurrent retinal ischemia beyond cervical carotid occlusions frequently results from microembolism via the ipsilateral ECA. Patients with this mechanism of postocclusion recurrent ischemia can be identified on the basis of clinical history, ophthalmological examinations, and complete cerebral arteriography. Termination of embolic phenomena should be the major treatment goal in these individuals, and ECA endarterectomy is recommended. Anticoagulant drugs are an effective alternative treatment in patients who are poor surgical risks.


1998 ◽  
Vol 89 (4) ◽  
pp. 533-538 ◽  
Author(s):  
Hun Cho ◽  
Edwin M. Nemoto ◽  
Howard Yonas ◽  
Jeffrey Balzer ◽  
Robert J. Sclabassi

Object. Cerebral ischemia that occurs during carotid endarterectomy is commonly monitored by means of somatosensory evoked potentials (SSEPs) and electroencephalography (EEG). The authors conducted this study to determine whether cerebral ischemia could also be reliably detected by cerebral oximetry. Methods. Twenty-nine patients who underwent carotid endarterectomy were monitored by means of SSEPs, EEG, and cerebral oximetry with a model NIRO500 (20 patients) or INVOS3100A (nine patients) oximeter. Changes in amplitude of SSEPs were graded as follows: 0, no change; 1, decrease of less than 50%; 2, decrease of greater than 50%; and 3, 100% decrease. As measured with the NIRO500 oximeter, closing the common caro-tid artery decreased mean oxyhemoglobin levels twice as much (p < 0.005) in the group with SSEPs of 1 to 3 (−13.11 ± 5.59 µM [mean ± standard deviation], 12 patients) as in the group with SSEPs of 0 (−6.22 ± 5.59 µM, eight patients). The rise in deoxyhemoglobin was also greater (p < 0.05). Two of nine patients monitored with the INVOS3100A oximeter had SSEPs of 1 and 3, and their regional saturation of oxygen (rSO2) values fell by −11.50 and −11.51, respectively. In the remaining seven patients with SSEPs of 0, the rSO2 ranged between −2.00 and −6.10 with no overlap with the group with SSEPs of 1 to 3. The increase in oxyhemoglobin monitored using the NIRO500 oximeter and rSO2 monitored using the INVOS3100A machine after opening the external carotid artery was less than that seen after opening the internal carotid artery. Both types of oximeters could detect cerebral ischemia but whereas false negatives occurred with the NIRO500, none was observed with the INVOS3100A. Extracranial contamination was also four times less frequent with the INVOS3100A than with the NIRO500 monitor. Conclusions. The results indicate that at least as measured with the INVOS3100A instrument, a decrease in rSO2 of −10 or more or a decrease below an rSO2 of 50 is indicative of cerebral ischemia of sufficient severity to decrease the amplitude of SSEPs.


1974 ◽  
Vol 41 (3) ◽  
pp. 396-398 ◽  
Author(s):  
Ruben E. M. Hekster ◽  
Bartolomeo Matricali ◽  
Willem Luyendijk

✓The authors report the technical details of a case in which, to reduce operative hemorrhage, branches of the external carotid artery feeding a large convexity meningioma were preoperatively embolized with Gelfoam plugs. The total blood loss during the successful resection of the tumor was 500 ml.


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