Angiography of the external carotid to internal carotid anastomosis

Summary The EC/IC bypass is being performed more and more, and angiography is essential as part of the postoperative evaluation. This review of 41 patients points out the need for selective external carotid angiography in those cases where intracranial vessels fill spontaneously at the same time as the shunt. However, 8 of 11 cases showed the superficial temporal artery to be larger on the selective external carotid angiogram than in the common carotid study done during the same session. In two cases undergoing staged occlusive procedures as treatment for giant aneurysm, the external carotid artery leading to an EC/IC was occluded as an angiographic complication without neurologic sequelae.     

Stent impact on the geometry of the carotid bifurcation and the course of the internal carotid artery

A measurement system is proposed to evaluate reconstructive effects of carotid stents on the geometry of the carotid bifurcation and the course of the internal carotid artery. To describe deviations of the stenotic internal carotid artery (ICA) from the extended axis of the common carotid artery (CCA) the CCA-ICA angle is measured between the CCA midaxis and the midaxis of the stenotic ICA segment. Maximal extensions of ICA tortuosities perpendicular to the course of the CCA axis are defined as ICA offset. The measurements were applied to DSA images of 224 carotid stenoses to evaluate variation and correlation between the two parameters. Comparative pre- and post-stent evaluation was performed in two series of 55 and 31 carotid stenoses treated with Wallstents and in a historic control group of 35 stenoses treated with Strecker stents. Straight course of the ICA was associated with low angle and low offset values, whereas tortuous course of the ICA showed larger angle and offset. A moderate linear correlation between the two parameters was found. Corresponding to a straightening of the stented segment, Wallstents reduced mean angle and offset values significantly. In five cases of the second series of Wallstents, transferrals of curves above the distal stent end associated with kinks were observed, and offset remained constant or increased. Strecker stent implantation caused no significant changes of bifurcational geometry. The proposed parameters corresponded to visual aspects of ICA tortuosity and detected reconstructive effects of self-expanding Wallstents on the ICA course. The measurement system may provide a basis for geometric evaluation of different stent types or implantation concepts with the aim: to optimize anatomic recanalization results in tortuous high angle-high offset bifurcations.     

Doppler-sonographic examination of the arterial flow in the carotid and supratrochlear arteries during carotid angiography

Summary In 55 patients, the blood flow in the carotid and supratrochlear arteries was examined by Doppler sonography during cerebral angiography. In general, a threefold response was observed: an initial phase of turbulence during the injection was followed by a phase of depressed and then of increased arterial flow. The second phase of reduced perfusion which probably is caused by the increased viscosity of the mixture of contrast medium and blood, is more pronounced in the internal carotid artery, whereas the third phase of accelerated flow is more marked in the external carotid artery. In patients with an occlusion of the internal carotid artery, the cerebral blood supply often depends on the collateral pathway via the ophthalmic artery. In these cases, the reduction of the blood flow is specially marked and long-lasting, as we could show. This may contribute to a higher angiographic risk of those cases with an important ophthalmic collateral flow.     

MRI of internal carotid occlusion and high-grade carotid stenosis

Magnetic resonance imaging (MRI) of twelve patients with angiographically proved internal carotid artery (ICA) occlusions and a patient with high-grade ICA stenosis was retrospectively reviewed. In one of the occluded ICA cases, the bilateral ICAs were involved. All patients were examined by a 1.5 Tesla system, using spin-echo pulse sequences. Both absence of normal flow void and decreased caliber of the cavernous portion of the ICA were detected in all patients. In ten of the thirteen occluded ICAs, flow void was completely absent. Most of the occluded arteries were isointense relative to gray matter on T1-weighted images, and were mildly hypointense on T2-weighted images. "Partial flow void" was observed in four cases, including the high-grade stenosis patient. So-called "border zone infarcts" were detected in seven patients (eight hemispheres). In three of the thirteen cases, however, cerebral infarcts relating to the ICA occlusions or high-grade stenosis were not observed. Since detection of abnormal ICA before cerebral infarct has occurred is extremely significant, we want to stress that abnormal ICA must be routinely searched for in the routine review of MRI of the head.     

Injury of the carotid and vertebral arteries

Summary A knowledge of the normal anatomy and anatomic relationships of the carotid and vertebral arteries, as well as the biomechanics by which traumatic injury occurs to these vessels, is important both in the interpretation of diagnostic arteriograms and in the clinical assessment of the injured patient.     

颈动脉分叉区解剖类型与动脉粥样硬化相关性的CTA评价

目的:利用多层螺旋CT血管成像(MSCTA)评价颈动脉分叉区(CCAB)解剖类型及其与动脉粥样硬化关系.方法:回顾性分析2005年～2008年在我院行颈动脉CT血管造影的78例受检者的156侧图像.CT机采用日本东芝Aquilion 16层螺旋CT机,扫描范围自主动脉弓上缘至颅底水平;对比剂使用碘海醇90～100ml.流速3ml/s;45例采用SURESTAR技术跟踪扫描,兴趣区设在主动脉弓,阈值120～160HU;33例采用经验值,扫描延迟时间设定为20s;图像后处理技术主要采用VR、MIP等.结果:CCAB形态中1型14侧,占8.97%;2型80侧,占51.2%;3型62侧,占39.7%.CCAB夹角大多数在21°～40°之间.78例受检者中,发现有斑块的血管43例、51处,其中:颈总动脉分叉处15处,颈总动脉11处,颈内动脉窦部17处,颈外动脉8处.43例斑块患者中累及47侧血管,其中:1型3侧,占6.38%;2型20侧.占42.55%;3型24侧.占51.06%.斑块在不同分叉角度的发生率:≤20°3侧.占6.38%;21°～50°18侧.占38.29%;≥51°26侧;占55.31%.结论:应用MSCTA可以准确评价CCAB的解剖,为进一步分析其与动脉粥样硬化的发生、发展提供了一种简便易行的技术.     

颈动脉分叉角与颈内动脉粥样硬化斑块厚度相关性的 CTA 分析

目的：利用多层螺旋CT血管成像(MSCTA)评价颈动脉分叉角与颈内动脉粥样硬化斑块厚度的相关性。方法回顾性分析行颈动脉 CT 血管造影的99例受检者。利用 GE AW4.4工作站进行图像分析,测量颈总动脉分叉角、颈内动脉分叉角、颈内动脉起始部斑块厚度及颈内动脉开口平均直径。根据颈总动脉分叉角、颈内动脉分叉角及颈内动脉分叉角标准化指数的大小分别对双侧颈内动脉斑块厚度进行分组,采用 SPSS16.0软件进行配对 t 检验(正态分布)或 Wilcoxon 符号秩和检验(非正态分布),对颈动脉分叉角与颈内动脉斑块厚度进行偏相关性分析,P <0.05为有统计学意义。结果各组颈内动脉斑块厚度间无差异(P >0.05)。偏相关分析示：颈总动脉分叉角分组中,颈总动脉分叉角与颈内动脉斑块厚度间相关系数 r 值为-0.020(P =0.849);颈内动脉分叉角分组中,颈内动脉分叉角与颈内动脉斑块厚度间相关系数 r 值为0.018(P =0.864);颈内动脉分叉角标准化指数分组中,颈内动脉分叉角标准化指数与颈内动脉斑块厚度间相关系数 r 值为0.005(P =0.962)。结论双侧颈动脉分叉角变化不会导致双侧颈内动脉起始部斑块厚度的差异。     

The cochlea and the carotid canal

The carotid canal conveys a large artery and lies in close topographic relationship to the basal turn of the cochlea. The bony wall between them consists in some cases only of the petrous bone of the otic capsule. It can be as thin as 0.2 mm. In other cases the distance can be more than 6 mm. A systematic assessment of the relationship between these two structures was performed on plastic casts of 173 human temporal bone specimens in order to investigate the range of normal variation. The topography in this region can be visualized by multidirectional tomography or CT.     

Changes in carotid flow velocity during catheterization of the aortic arch and common carotid artery

Summary Quantitative percutaneous flow velocity measurements are possible in carotid arteries by means of a directional Doppler flow velocity device and registration on a polygraph. Carotid flow velocity changes were recorded during catheterization of the ascending aorta and common carotid artery and after infusion of 20 cc contrast medium in the ascending aorta. The results indicate an increase in the flow velocity in the right common carotid artery after infusion of the contrast medium in the ascending aorta, which is thought to be attributed to a diffuse vasodilatation, at least in the cerebral circulation. The catheterization of the ascending aorta and common carotid artery seems to interfere with the common carotid flow velocity.     

增强磁共振成像与颈动脉造影在颈动脉狭窄诊断中的应用价值

目的：探讨增强磁共振成像与颈动脉造影在颈动脉狭窄诊断中的应用价值。方法对72例经颈动脉彩超检查疑有颈动脉狭窄的患者采用三维对比增强磁共振血管造影和数字减影血管造影进行检查。结果3D CE-M RA检出颈动脉狭窄112处,DSA检出108处,经统计学分析发现3D CE-M RA检出率（36．84％）与DSA检出率（35．53％）比较无明显差异（x2＝0．11,P ＞0．05）。本文以DSA为诊断颈动脉狭窄的金标准,对3D CEMRA诊断的112处颈动脉狭窄进行敏感性和特异性评估,评估结果显示敏感性为0．81（0．69～0．89）特异性为0．99（0．98～1．00）,ROC曲线下面积为0.95。结论3D CE-M RA诊断颈动脉敏感性和特异性均较高,对颈部动脉狭窄闭塞性病变的显示具有独特的优势。     

Intracranial carotid anastomosis and partial aplasia of an internal carotid artery

Summary A rare arterial anastomosis between the right and left internal carotid arteries at the base at the skull, with aplasia of the cervical part of the left internal carotid artery is reported. The case is unusual because, in addition to the vascular anomaly of the carotid artery, there is an aneurysm of the anterior communicating artery and bilateral renal cysts. The condition is a complex malformation syndrome caused by defective regression of the third branchial artery. Because of the characteristic angiographic aspects such a case should be called transverse carotid anastomosis.Dedicated to Professor Dr. Friedrich Loew on his 60th birthday     

影像学在诊断颅外颈动脉狭窄及内膜切除术后随访中的应用

目的：对一例颈内动脉狭窄进行内膜切除术前后影像学系列观察,结合文献复习,初步探讨磁共振血管造影（MRA）,CT血管造影（CTA）,CT仿真内窥镜（CTVE）技术在诊断颈动脉狭窄中的应用价值。材料与方法：MRA采用TOF法,2D移动预饱和序列（Travelsat)及3D最佳倾斜非饱和激励（TONE）序列。CTA：Hispeed CT/i扫描机,经最大密度投影（maximum intensity projection,MIP)及遮盖表面显示法（threshold shaded surface display,SSD)行血管3D重建。CTVE：应用导航（Navigator smooth)功能实施颈动脉CTVE成像。将上述检查结果与数字减影血管造影（DSA）,手术对照。结果：96年MRA显示左颈内动脉狭窄30％,99年呈重度狭窄约90－95％。CTA：血管狭窄部位及程度同MRA,狭窄段可见钙化斑块。CTVE获得颈内动脉狭窄腔内仿真内窥镜图像,显示管增厚,钙化。DSA诊断左颈内动脉重度狭窄,病理证实。术后MRA,CT提示狭窄基本解除,钙化斑块消失。结论：MRA可用于发现,诊断外颈动脉狭窄及术后随访,CTA与CTVE有利于观察管腔内病理改变。