Visualization of Internal Carotid Artery Atherosclerotic Plaques in Symptomatic and Asymptomatic Patients: A Comparison of Optical Coherence Tomography and Intravascular Ultrasound

The pathophysiology of extracranial traumatic aneurysm formation has not been fully elucidated. Intraarterial optical coherence tomography (OCT), an imaging modality capable of micrometer cross-sectional resolution, was used to evaluate patients presenting with saccular traumatic aneurysms of the internal carotid artery (ICA). Two consecutive trauma patients diagnosed with saccular traumatic aneurysms of the cervical ICA, per the institutional screening protocol for traumatic cerebrovascular injury, underwent digital subtraction angiography (DSA) with OCT. Optical coherence tomography demonstrated disruption of the intima with preservation and stretching of the more peripheral layers. In 1 patient the traumatic aneurysm was associated with thrombus formation and a separate, more proximal dissection not visible on CT angiography (CTA) or DSA. Imaging with OCT indicates that saccular traumatic aneurysms may develop from disruption of the intima with at least partial preservation of the media and adventitia. This provides in vivo evidence that saccular traumatic aneurysms result from a partial arterial wall tear rather than complete disruption. Interestingly, OCT was also able to detect arterial injury and thrombi not visible on CTA or DSA.

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Extracranial internal carotid artery: anatomical variations in asymptomatic patients

Surgical and Radiologic Anatomy ◽

10.1007/s00276-016-1652-7 ◽

2016 ◽

Vol 38 (8) ◽

pp. 893-902 ◽

Cited By ~ 5

Author(s):

Salvatore Cappabianca ◽

Francesco Somma ◽

Alberto Negro ◽

Michele Rotondo ◽

Assunta Scuotto ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Anatomical Variations ◽

Extracranial Internal Carotid Artery ◽

Asymptomatic Patients

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Determinants of Micro-embolic Signals in Patients with Atherosclerotic Plaques of the Internal Carotid Artery

Journal of Vascular Surgery ◽

10.1016/j.jvs.2009.06.033 ◽

2009 ◽

Vol 50 (2) ◽

pp. 470

Author(s):

G. Telman ◽

E. Kouperberg ◽

A. Hlebtovsky ◽

E. Sprecher ◽

A. Hoffman ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Atherosclerotic Plaques ◽

Embolic Signals

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Aneurysms of the petrous internal carotid artery: anatomy, origins, and treatment

Neurosurgical FOCUS ◽

10.3171/foc.2004.17.5.13 ◽

2004 ◽

Vol 17 (5) ◽

pp. 1-9 ◽

Cited By ~ 37

Author(s):

James K. Liu ◽

Oren N. Gottfried ◽

Amin Amini ◽

William T. Couldwell

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Wide Spectrum ◽

Treatment Options ◽

Signs And Symptoms ◽

Current Treatment ◽

Asymptomatic Patients ◽

Cranial Nerve Palsies ◽

Close Observation

Aneurysms arising in the petrous segment of the internal carotid artery (ICA) are rare. Although the causes of petrous ICA aneurysms remain unclear, traumatic, infectious, and congenital origins have been implicated in their development. These lesions can be detected incidentally on routine neuroimaging. Patients can also present with a wide spectrum of signs and symptoms, including cranial nerve palsies, Horner syndrome, pulsatile tinnitus, epistaxis, and otorrhagia. The treatment of petrous ICA aneurysms remains challenging. Treatment options include close observation, endovascular therapies, and surgical trapping with or without revascularization. Management dilemmas exist, particularly for incidental lesions found in asymptomatic patients. The authors review the literature and discuss the anatomy of the petrous ICA as well as the pathophysiological features of aneurysms arising in this region, and they propose a management paradigm with current treatment options.

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Chlamydia pneumoniae, Herpes simplex virus and Cytomegalovirus in symptomatic and asymptomatic high-grade internal carotid artery stenosis. Does infection influence plaque stability?

VASA ◽

10.1024/0301-1526.34.3.163 ◽

2005 ◽

Vol 34 (3) ◽

pp. 163-169 ◽

Cited By ~ 12

Author(s):

Müller ◽

Huber ◽

Henrich ◽

Adams ◽

Berns ◽

...

Keyword(s):

Herpes Simplex Virus ◽

Herpes Simplex ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Chlamydia Pneumoniae ◽

Internal Carotid ◽

Internal Carotid Artery Stenosis ◽

High Grade ◽

Asymptomatic Patients ◽

Simplex Virus

Background: Current debates are focused on inflammatory processes in atherosclerotic lesions as a possible pathomechanism for destabilization and thrombembolism. In this prospective study the role of systemic and local infection in patients with high-grade internal carotid artery stenosis (ICA) was evaluated. Patients and methods: Serum antibody titers of 109 consecutive patients, who underwent surgery for ICA stenosis (asymptomatic n = 40, symptomatic n = 69) were prospectively measured for Chlamydia pneumoniae (Cpn) (IgA and IgG), Herpes simplex virus (HSV) (IgG, IgM) and Cytomegalovirus (CMV) (IgG, IgM) respectively. 53 carotis plaques of this group (asymptomatic n = 17, symptomatic n = 36) could be analyzed by polymerase chain reaction (PCR) for Cpn-, HSV- and CMV-DNA presence. Results: Seropositivity was found in 61,5% for Cpn, 91,7% for HSV and 72,5% CMV respectively. No significant relation was found between symptomatic and asymptomatic patients as well as no difference was seen for presence of IgA antibodies against Cpn comparing both groups. Plaque-PCR revealed Cpn in 7 cases (13,2%), HSV in 2 cases (3,8%) and no CMV had been detected. Again, no significant relationship was found concerning symptomatic and asymptomatic patients. All 9 PCR-positive plaques displayed lesions of "complicated atherosclerosis" as central fibrous necrosis and calcification or plaque bleeding and surface thrombosis. Conclusions: Our results do not support the hypothesis that systemic Cpn, HSV or CMV- infection or evidence of Cpn-, HSV- or CMV-DNA in carotid plaques causes plaque destabilization and cerebral thromboembolism. Plaque infection could only be observed in cases with advanced atherosclerosis.

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