Agenesis of the internal carotid artery: two cases report

The authors report two cases of agenesis of the internal carotid artery evaluated with MR angiography allows the diagnosis of the internal carotid artery agenesis and appreciates both the supply post.     

Duplication of the internal carotid artery

Summary The angiographic appearance of a duplicated internal carotid artery is described.     

Tortuous internal carotid artery narrowing pyriform sinus: two cases

An elongation of the internal carotid artery should be classified as a tortuosity or a kink. Tortuosity of the carotid artery is rarely seen in otolaryngologic practice. In videolaryngoscopic examination, bilateral pyriform sinus narrowing was found in one patient and unilateral pyriform sinus narrowing in the other patient. Computed tomographic scans showed tortuous internal carotid artery in both patients. Awareness of the possible internal carotid artery tortuosity is very important to prevent serious complications during laryngeal and pharyngeal surgical procedures.     

Lateralized petrous internal carotid artery: imaging features and distinction from the aberrant internal carotid artery

Introduction

This study aimed to describe the lateralized petrous internal carotid artery (ICA), a rare variant of the intratemporal course of the ICA, and distinguish it from aberrant ICA.

Methods

A retrospective multi-institutional review of all patients diagnosed over a 10-year period with lateralized ICA was completed. Medical records were reviewed for demographic data as well as clinical information in all patients. Computerized tomography (CT) studies were reviewed in all patients. Magnetic resonance studies in this patient group were reviewed when available. In order to obtain normative data for the ICA, the intratemporal course of the ICA was evaluated on 50 consecutive high-resolution sinus CT scans.

Results

Sixteen cases of lateralized ICA were identified on CT scans in 12 patients. In each of these, the ICA entered the skull base in a position more lateral to the cochlea than normal and protruded into the anterior mesotympanum with dehiscent or thinned overlying bone. Magnetic resonance angiography was available in 5 of 12 patients and catheter angiography in 1 of 12.

Conclusion

Lateralized petrous ICA can be identified on CT by its more posterolateral entrance to the skull base and protrusion into the anterior mesotympanum. It can be distinguished from the aberrant ICA which enters the posterior hypotympanum through an enlarged inferior tympanic canaliculus, then courses across the inferior cochlear promontory to connect with the normal horizontal petrous ICA. Lateralized ICA is best considered an incidental petrous ICA variant. Awareness of this entity is important in the presurgical evaluation of the temporal bone to avoid vascular injury and confusion with the congenital diagnosis of aberrant ICA.     

Pseudo-aneurysm of the internal carotid artery]

The authors recall the anatomy of the deep neck spaces and report the case of a 3-year-old girl with a parapharyngeal abscess followed by a pseudo-aneurism of the carotide artery. Ultrasonography, CT scan and angiography findings are described. This case puts in mind of the seriousness of neck abscesses. Each specific anatomical location must be definite for a better therapeutic approach on account of hemorrhagic risks of parapharyngeal abscesses.     

Extracranial aneurysms of the internal carotid artery

Summary Aneurysm of the internal carotid artery in its cervical portion is not a benign lesion. A sufficient number of cases has been reported to serve as a warning that a unilateral lump in the throat may be an aneurysm and should be so regarded until proved otherwise. Neurological manifestations, particularly signs and symptoms of cerebral ischemia are common. Angiography is essential for diagnosis and provides valuable information regarding the size and location of the lesion, in addition to demonstrating associated cerebral hemodynamic disturbances.

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Extracranielle Aneurysmen der A. carotis interna

Zusammenfassung Aneurysmen der A. carotis int. im Halsabschnitt können neurologische Ausfallsercheinungen und auch Symptome einer cerebralen Mangeldurchblutung verursachen. Die Arteriographie ist zur Diagnose unbedingt erforderlich, damit kann die Lokalisation und die Größe des Aneurysmas bestimmt werden, auch lassen sich damit die cerebralen hämodynamischen Veränderungen erkennen. Ausführlicher Bericht über die Genese dieser Aneurysmen.

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Anevrysmes extra-craniens de l'artere carotide interne

Résumé L'anévrysme de l'artère carotide interne dans son segment cervical n'est pas une lésion bénigne. Un certain nombre de cas ont été observés, uffisants pour nous avertir qu'une masse unilatérale dans la gorge peut être un anévrysme et doit être considéré comme tel jusqu'á preuve du contraire. Les manifestations neurologiques, les signes particuliers et les symtômes d'ischémie cérébrale sont, communs. L'angiographie est essentielle pour le diagnostic et apporte des informations de valeur quant á la taille et á la localisation de la lésion, en plus des troubles hémodynamiques cérébraux démonstatifs associés.

     

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.     

Angioplasty of the occluded internal carotid artery.

PURPOSETo review patients who have presented with acute strokes from a middle cerebral artery occlusion in whom in addition to the middle cerebral artery thromboembolus, an internal carotid artery occlusion has been present, and in whom angioplasty of these totally occluded internal carotid arteries has bee n successful.METHODSWe reviewed retrospectively our experience in treating a cute stroke patients with intracranial, intraarterial urokinase. Six of 27 patients had internal carotid artery occlusions in addition to middle cerebral artery occlusions. Two patients presented with spontaneous carotid dissections for wh ich no further intervention from the ipsilateral internal carotid artery was attempted. In the remaining four internal carotid artery occlusions secondary to atherosclerotic disease, standard guide wires and catheters were negotiated across the level of the internal carotid artery occlusion, which expedited intracranial catheterization for thrombolysis. Subsequently, angioplasty of the internal carotid artery was performed.RESULTSAll four occluded internal carotid arteries could be traversed. No new neurologic deficits occurred. No vascular injuries occurred. No deaths occurred. Four- to 6-month follow-up showed all four internal carotid arteries remained patent.CONCLUSIONIn acute occlusions of the internal carotid artery from atherosclerosis, the occluded vessel can sometimes be recanalized with low morbidity. In addition, endovascular access to the intracranial circulation can be expedited by using the recanalized internal carotid artery.     

Bilateral congenital absence of the internal carotid artery

European Radiology - Bilateral congenital absence of the internal carotid artery was incidentally found in an 11-year-old boy. Magnetic resonance imaging showed a normal-appearing brain that was...     

Duplication of the extracranial internal carotid artery.

We describe a case of duplication of the left internal carotid artery from a point 1 cm distal to the origin to the proximal petrous segment where the vessel reunites. Duplication and fenestration of the internal carotid artery are discussed. A review of embryologic development is presented. Identification of these entities is important, especially in patients who require surgical intervention involving the internal carotid artery.