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At least 19 recordsLinked to original sources
PubMed2000

Aneurysms at nonbranching sites in the surpaclinoid portion of the internal carotid artery: internal carotid artery trunk aneurysms.

OBJECTIVE: Aneurysms at nonbranching sites in the supraclinoid internal carotid artery (ICA), known as blood blister-like aneurysms or ICA anterior or dorsal wall aneurysms, are not well understood. To clarify this clinical entity, 7408 patients with subarachnoid hemorrhage who were treated during a 5-year period were analyzed. METHODS: Forty-eight patients had aneurysms that were intraoperatively confirmed to be located at a nonbranching site in the supraclinoid portion of the ICA. Neuroradiological and clinicopathological features and outcomes were studied. RESULTS: The aneurysms were divided into the "blister type," with a blood blister-like configuration and fragile walls, and the "saccular type," with a saccular configuration and a relatively firm neck, like ordinary berry aneurysms. The most frequent origin was the anteromedial wall for both types. ICA dissection was associated only with the blister type, and hypertension was more frequent with the blister type (P = 0.0978). The preoperative conditions of the patients were the same, but the outcomes for patients with blister-type aneurysms were worse, because of frequent intra- and postoperative aneurysmal bleeding. Saccular-type aneurysms were safely clipped. Treatment of blister-type aneurysms by clipping on wrapping material achieved good results, but ICA trapping (P = 0.0952), clipping (P = 0.0146), and wrapping (P = 0.0110) were associated with much worse results. CONCLUSION: Blister-type and saccular-type aneurysms have different shapes and wall characteristics. The saccular type can be treated by clipping, whereas the blister type requires clipping on wrapping material. ICA trunk aneurysms may be a better designation to express the diversity of these aneurysms, rather than ICA blood blister-like or anterior or dorsal wall aneurysms.

Adult↗
PubMed1992

[Sympathetic postganglionic innervation of external carotid artery, internal carotid artery, common carotid artery and aorta in the dog--experimental study using HRP and WGA-HRP].

The sympathetic postganglionic innervation of the external carotid artery, internal carotid artery, common carotid artery (CCA) and aorta was studied by using retrograde axonal transport of the horseradish peroxidase (HRP) and wheat germ agglutinin-HRP conjugates (WGA-HRP). When the powder of HRP was applied to the sheaths of internal and external carotid arteries, labeled cells were found only in the ipsilateral superior cervical ganglion (SCG). After injection of WGA-HRP into the walls of the (1) distal, (2) middle, and (3) proximal parts of the CCA, labeled cells were observed in the following ganglia, respectively; (1) the SCG and middle cervical ganglion (MCG), (2) the SCG, MCG and stellate ganglion (SG), and (3) the MCG and SG. These labeled cells were seen in these ganglia of both sides, but they were more marked ipsilaterally. Following injections of WGA-HRP into the walls of ascending and descending aortae, labeled cells were found in the bilateral MCG and SG. These results suggest that the vasodilation of the head and neck after stellate ganglion block using local anesthetic agents is caused by neuronal block of preganglionic sympathetic fibers passing through the stellate ganglion and terminating in the superior cervical ganglion.

Animals↗
PubMed2001

[The site and extent of arteriosclerosis. Comparative planimetric studies of the left descending coronary artery, internal carotid artery, superficial femoral artery and abdominal aorta in 104 cadavers].

BACKGROUND: Arteriosclerosis is generally considered to be a generalized disease, involving different vascular regions to approximately the same extent. PATIENTS AND METHODS: In order to assess the extent of ateriosclerosis quantitatively, all arteriosclerotic lesions and additionally the complicated (calcified, ulcerated, thrombosed) arteriosclerotic lesions of the abdominal aorta, the superficial femoral arteries, the left descending coronary artery and the internal carotid arteries were measured by planimetry in 102 autopsies (64 male, 38 female; mean age: 62 +/- 16 years). RESULTS: Arteriosclerosis increased with age. The overall extent of arteriosclerotic lesions of each artery was classified to one of the following 4 degrees of intimal involvement (0-25, 26-50, 51-75%, 76-100%). When comparing the 4 different vascular regions of each patient we found maximal deviations by 1 degree in 34%, by 2 degrees in 41% and by 3 degrees in 20%. In only 5% of the patients studied were all arteriosclerotic lesions of the same degree. In order to analyze the complicated plaques 7 degrees were used (intimal involvement: 0, 1-10, 11-20, 21-30, 31-40, 41-50% and > 50%). In 14 patients we found no complicated plaques. The remaining 88 showed complicated lesions in at least 1 vascular region. Deviations by 1 degree were found in 22%, by 2 degrees in 32%, and by 3 or more degrees in 46%. In the paired arteries (carotid, femoral) there were no significant differences comparing the mean values of the extent of arteriosclerotic lesions on the right and left side. In many cases, however, remarkable intraindividual differences occurred. Patients with main risk factors usually had more pronounced arteriosclerotic lesions than those without. In patients who died from coronary artery disease the extent of arteriosclerotic lesions was also usually larger in the other vascular regions as compared to those patients who died from other reasons. Comparing postmortem and intravital extent of arteriosclerotic lesions some peculiarities of postmortem specimens should be considered. CONCLUSIONS: A uniform involvement of all vascular regions by arteriosclerosis occurs only rarely. Considerable intraindividual differences are the rule and a severe, generalized uniform affection is an exception. This, however, does not exclude in patients with severe arteriosclerosis of one region that a larger involvement of other vascular regions may also occur, as this was found for patients with severe arteriosclerosis in coronary arteries. Regarding the extent of arteriosclerosis there are artery- and additional localization-specific features.

Adult↗
PubMed1999

An aneurysm of the petrous internal carotid artery.

Internal carotid artery aneurysms are a rare cause of pulsatile tinnitus and conductive hearing loss but should be borne in mind when there is a suspected diagnosis of glomus jugulare or high-riding jugular bulb. Most cases are congenital. We present a case of otorrhagia which was initially thought to be a glomus jugulare, the diagnosis of internal carotid artery aneurysm was made at angiography and treated by balloon embolization.

Adult↗
PubMed2002

Surgical management of aneurysms of the bifurcation of the internal carotid artery.

Internal carotid artery (ICA) bifurcation aneurysms are rare and easily bleed in younger patients, but are difficult to treat surgically, due to perforators surrounding and adherent to the aneurysm. A series of 25 patients treated by clipping under the operating microscope are analyzed and compared with previous cases. Twenty-five patients, 11 men and 14 women (mean age 51 years), were treated by the same neurosurgeon. Seventeen patients presented with subarachnoid hemorrhage (Hunt & Kosnik Grade I in three, II in five, III in two, IV in seven), five with unruptured ICA bifurcation aneurysms, and three with unruptured ICA bifurcation aneurysms but another ruptured aneurysm. There were 23 small, one large, and one giant ICA bifurcation aneurysms. The projection was superior in 12, anterior in seven, and posterior in six cases. Pterional approach was employed for all cases. Outcomes were evaluated at discharge with the Glasgow Outcome Scale. Favorable outcomes (good recovery (GR) and moderate disability (MD)) were obtained in ten of 17 patients with ruptured ICA bifurcation aneurysm. Favorable outcomes were significantly greater in Grades I and II (three in I, four in II) than in Grades III and IV (one in III, two in IV; P=0.0498). Seven of eight patients with unruptured ICA bifurcation aneurysm had favorable outcomes. Temporary clipping and projection of the aneurysm did not affect the outcome. Causative factors of unfavorable outcomes were primary brain damage in cases of small and large aneurysms and perforator damage in the case of giant aneurysm. Poor clinical grade and vasospasm are the causative factors of poor outcome in patients with ruptured ICA bifurcation aneurysm. Preservation of perforators is crucial in cases of giant aneurysm. Clipping of unruptured ICA bifurcation aneurysms is recommended since they tend to bleed at a lower age than other aneurysms.

Brain↗
PubMedDate not supplied

A morphometric study of age-related changes in the elastic systems of the common carotid artery and internal carotid artery in humans.

The present study aims to quantify the distribution of the elastic fiber system in the walls of the common carotid artery and the internal carotid artery in humans. In order to identify specific fibers, segments of carotid arteries were stained using the Verhoeff (for elastic fibers), Weigert (for elastic and elauninic fibers) and Weigert-oxone (for elauninic and oxytalanic fibers) methods. A histomorphometric study was undertaken in order to estimate the linear density (LV) of the fibrous components present in the elastic system and determine the total length of these components in each segment. Microscopic fields were sampled using a test system in which the colors and bands defined in the current study were superimposed on the histological preparations. Data were analyzed through linear regression using first-order rate equations and computer software. The internal carotid artery can be loosely defined as muscular in nature. In order to classify common carotid arteries, it is necessary to consider subject age. From 0 to 30 years of age, the LV of mature elastic fibers does not change significantly in either (left or right) common carotid artery, although a significant reduction in the LV of this type of fiber occurs in the right internal carotid artery. The most marked reduction in oxytalanic and elauninic fibers occurs between 0 and 10 years of age, becoming less intense between the ages of 10 and 30.

Adult↗
PubMedDate not supplied

External carotid artery in internal carotid artery occlusion. Angiographic, therapeutic, and prognostic considerations.

Twenty-three instances of internal carotid artery occlusion occurring with minimal neurological deficit in 22 patients are described. Although each of these patients was referred to the neurosurgical service for evaluation for an extracranial-intracranial microvascular bypass procedure, complete arteriographic evaluations of their cerebrovasculature suggested that alternative methods should be the treatment of choice. For each patient reported the ipsilateral external carotid artery was demonstrated by angiography to be an important source of collateral blood supply to the cerebral hemispheres or retinae distal to the occluded internal carotid arteries. Ten patients with no significant atherosclerotic narrowing or ulceration of the external carotid artery have remained free of symptoms of cerebral ischemia for 6 to 40 months. In twelve patients who developed delayed recurrent cerebral or retinal ischemia ipsilateral to their internal carotid artery occlusion, there were found obstructive and/or ulcerative plaques involving the common and/or external carotid arteries. Thromboendarterectomy in 11 of these patients gave complete relief of ischemic symptoms during the 4 to 36 months of postoperative follow up. One of these 12 patients refused operation and went on to develop a major cerebral infarction. Angiographic identification of a functionally important external carotid artery ipsilateral to an internal carotid artery occlusion carries considerable prognostic and therapeutic significance.

Adult↗
PubMed1994

[Internal carotid artery agenesis and multiple aneurysms in the posterior communicating artery].

Internal carotid artery agenesia is a rare anomaly of the embryonic development. We present a case with this anomaly and a vascular feeding of this territory out of the contralateral carotid system and the posterior vascular system. There were multiple aneurysms in the right posterior communicating artery, never described before in association with carotid agenesia, that are similar to the angiographic image of the fibromuscular dysplasia ("atypical" pattern). We review and discuss the embryonic development of this anomaly and its relationship with the hemodynamic stress and aneurysm formation.

Adult↗
PubMedDate not supplied

Spontaneous thrombosis of a giant intracavernous internal carotid artery aneurysm and ipsilateral internal carotid artery occlusion.

A 75-year-old man who had suffered from right visual disturbance for 10 years suddenly experienced right cavernous sinus syndrome. Magnetic resonance imaging revealed a giant thrombosed aneurysm in the right cavernous sinus extending to the right middle cranial fossa. Digital subtraction angiography disclosed occlusion of the right internal carotid artery at the petrous portion and good cross filling in the right-sided circulation through the anterior communicating artery. There was no filling of the aneurysm. In this case, the mechanism of parent artery occlusion is unclear, but direct compression and stretching of the parent artery by the aneurysm may be involved.

Aged↗
PubMed1999

Correlation of flow probe determinations of common carotid artery blood flow and internal carotid artery blood flow with microsphere determinations of cerebral blood flow in piglets.

We investigated whether blood flow determined by a flow probe situated on one common carotid artery provided an accurate estimation of unilateral cerebral blood flow (CBF) in piglets. In eight anesthetized, mechanically ventilated piglets, blood flow determined by an ultrasonic flow probe placed on the right common carotid artery was correlated with CBF determined by microspheres under two experimental conditions: 1) before ligation of the right external carotid artery with both the right external and internal carotid circulations intact [common carotid artery blood flow (CCABF) condition], and 2) after ligation of the right external carotid artery (ipsilateral to the flow probe) with all residual right-sided carotid artery blood flow directed through the right internal carotid artery [internal carotid artery blood flow (ICABF) condition]. The left carotid artery was not manipulated in any way in either protocol. Independent correlations of unilateral CCABF and ICABF with microsphere-determined unilateral CBF were highly significant over a 5-fold range of CBF induced by hypercarbia or hypoxia (r = 0.94 and 0.92, respectively; both p < 0.001). The slope of the correlation of unilateral CCABF versus unilateral CBF was 1.68 +/- 0.19 (SEM), suggesting that CCABF overestimated CBF by 68%. The slope of the correlation of unilateral ICABF versus unilateral CBF did not differ significantly from unity (1.06 +/- 0.15), and the y intercept did not differ significantly from zero [-1.3 +/- 5.2 (SEM) mL]. Consequently, unilateral ICABF determined by flow probe accurately reflected unilateral CBF determined by microspheres under these conditions. Flow probe assessments of CCABF and ICABF in piglets may provide information about dynamic aspects of vascular control in the cerebral circulation that has heretofore been unavailable.

Animals↗
PubMed2004

Saphenous vein graft for bypass of the external carotid artery to supraclinoid internal carotid artery using a modified technique: an anatomical and technical study.

OBJECTIVE: To investigate the use of a saphenous vein graft for bypass of the external carotid artery (ECA) to supraclinoid internal carotid artery (ICA) when the proximal middle cerebral artery (MCA) is not suitable for a bypass procedure. MATERIAL AND METHODS: Five adult cadaver sides were used. Dissection required a frontotemporal craniotomy and a zygomatic arch osteotomy, with a hole being opened 2-3 mm lateral to the foramen rotundum extradurally. The ECA was found easily via a second incision in the cervical region. The ophthalmic segment of the ICA was exposed by removal of the anterior clinoid process intradurally. After the dura over the hole was opened, the 7-8-cm long bypass graft was passed just behind the mandibula and through the hole inside the dura to reach the ICA. The ECA was then transected proximal to the occipital artery (OA) branch and the distal side of the vein graft was anastomosed end-to-end with the ECA and end-to-side with the supraclinoid ICA. RESULTS: The mean diameter of the ECA proximal to the OA was 3.75+/-0.4 mm (range 3.35-4.15 mm) and that of the supraclinoid ICA was 3.4+/-0.5 mm (range 2.9-3.9 mm). The mean length of the venous graft was 7.5+/-0.5 cm (range 7-8 cm). CONCLUSION: When high blood flow is needed and the proximal MCA is not suitable for a bypass, the bypass described herein may be an alternative to a superficial temporal to MCA bypass as well as to extracranial carotid artery to MCA or ICA bypasses, which both need long vein grafts.

Carotid Artery, External↗
PubMed1999

Continued lodging of retinal emboli in a patient with internal carotid artery and ophthalmic artery occlusions.

Internal carotid artery or ophthalmic artery occlusions are devastating ophthalmological events which lead to severe impairment of vision. A case of multiple branch retinal artery occlusions in a 63-year-old male with internal carotid artery and ophthalmic artery occlusions on brain angiography is presented. Emboli lodging in branches of the retinal arteries were bright, glistening, yellow or orange in appearance. Such a distinctive ophthalmoscopic appearance led to the diagnosis of cholesterol emboli. Fluorescein and indocyanine green angiography disclosed delayed filling of the retinal vessels and choroid, and showed multiple hypofluorescence distal to the vessels in which the emboli were lodged. At the time of initial examination, the number of emboli lodged in retinal arteries was estimated at more than 20. As time passed, a few of the previous emboli disappeared and new emboli appeared in other sites on fundus examination. We think that the lodging of new emboli in other sites is due to the continued break-up of atheromatous tissue through the collateral circulation associated with the occlusion of the internal carotid and ophthalmic arteries.

Acute Disease↗