Association between internal carotid artery morphometry and posterior communicating artery aneurysm

PURPOSE: The goal of this study was to directly measure the association between the internal carotid artery (ICA) morphometry and the presence of ICA-posterior communicating artery (PCOM) aneurysm. MATERIALS AND METHODS: The authors intraoperatively measured the length of the supraclinoid ICA because it is impossible to radiologically determine the exact location of the anterior clinoid process. We used an image analyzer with a CT angiogram to measure the angle between the skull midline and the terminal segment of the ICA (ICA angle), as well as the diameter of the ICA. The lengths and diameters of the supraclinoid ICA and the ICA angle were compared among PCOM aneurysms, anterior communicating artery (ACOM) aneurysms, and middle cerebral artery (MCA) bifurcation aneurysms (n=27 each). Additionally, the lengths and the diameters of M1 and A1 were compared for each aneurysm. RESULTS: The lengths of the supraclinoid ICA were 11.9+/-2.3 mm. The lengths of the supraclinoid ICA in patients with ICA-PCOM aneurysms (9.7+/-2.8 mm) were shorter than those of patients with ACOM aneurysms (13.8+/-2.2 mm, Student's t-test, p<0.001) and with MCA bifurcation aneurysms (12.2+/-1.9 mm, Student's t-test, p<0.001). The diameters of the supraclinoid ICA and A1 in patients with ACOM aneurysms were larger than those in patients with MCA bifurcation aneurysms (Student's t-test, p<0.05). There were no significant differences in the lengths of M1 and A1, ICA angle, or diameter of M1 for each aneurysm. CONCLUSION: These results suggest that the relatively shorter length of the supraclinoid ICA may be a novel risk factor for the development of ICA-PCOM aneurysm with higher hemodynamic stress.     

锁骨下动脉、颈总动脉和椎动脉分叉处血流动力学数值模拟

目的:探讨锁骨下动脉、颈总动脉和椎动脉分叉处的血流动力学特性,分析该处发生血管狭窄引起大脑供血不足的 血流动力学原因。方法:采用内蒙古民族大学附属医院神经内科提供的CT数据,应用医学建模软件MIMICS20.0将患者 二维CT数据进行三维血管重建,经过网格划分及边界条件设置后导入计算流体力学软件FLUENT14.5中。计算和分析 不同血液入口速度的锁骨下动脉、颈总动脉和椎动脉分叉处的血流动力学特性。结果:在血液入口速度不同的情况下,锁 骨下动脉、颈总动脉和椎动脉分叉处的血液流场分布、血液压力分布和血管壁面切应力分布有显著变化。在血液入口速 度增大时,锁骨下动脉分叉处和颈总动脉分叉处的血液流速快、血管壁压力大,颈总动脉内侧血管壁面切应力大,但锁骨 下动脉分叉处和颈总动脉分叉处血管壁面切应力数值和变化幅度小,属于低切应力区。结论:通过血流动力学数值模拟 研究,分析锁骨下动脉、颈总动脉和椎动脉分叉处易发生粥样斑块病变导致大脑供血不足的血流动力学原因。     

颈动脉的形态与动脉粥样硬化的解剖学观测

目的研究颈动脉的形态与动脉粥样硬化的情况,为颈总、颈内动脉狭窄的诊治提供形态学基础。方法解剖观测成尸30(男24、女6)侧颈动脉,观测颈动脉的形态及动脉粥样硬化情况。结果①颈总动脉中段外径,左侧(8.75±1.56)mm;右侧(8.31±0.99)mm。②颈内动脉根部外径,左侧(8.15±1.42)mm;右侧(7.51±1.63)mm。③颈外动脉中段外径,左侧(4.87±1.09)mm;右侧(4.39±0.89)mm。④颈动脉粥样硬化发生率占60%(18侧),其中颈内动脉根部四壁明显动脉硬化,内腔直径1.6mm严重狭窄1侧,占总数的3.33%。结论颈动脉粥样硬化发生率最高为颈动脉窦,占颈动脉硬化标本的100%,可致颈内动脉内腔狭窄。     

颈总动脉分叉部在不同体位条件下的变化

在不同体位条件下,观察了33具成人尸体颈总动脉分叉处的高度及颈外动脉和颈内动脉起始段的位置关系与变化规律,以便为临床上暴露颈总动脉分叉处的血管,施行有关血管手术提供参考资料.     

Endovascular treatment of bilateral carotid artery occlusion with concurrent basilar apex aneurysm: a case report and literature review

We report a case of successful endovascular treatment of bilateral carotid artery occlusion with concurrent basilar apex aneurysm. An elderly female patient with subarachnoid hemorrhage (SAH) onset was admitted to the hospital. Computed tomography (CT) and digital subtraction angiography (DSA) confirmed the presence of bilateral carotid artery occlusion with concurrent basilar apex aneurysm. Brain blood supply was provided by the bilateral vertebral artery through the basilar artery. We treated the aneurysm with the endovascular approach by embolizing the aneurysm with three coils. The patient recovered well after surgery and showed no recanalization of the aneurysm on a one-year follow-up DSA. We also reviewed six similar cases found with a PUBMED database search (1980-2010), including those with bilateral common carotid artery occlusion. In conclusion, by using the endovascular approach, bilateral carotid artery occlusion with concurrent basilar apex aneurysm was efficiently treated.     

Giant intracavernous internal carotid artery aneurysm with fatal epistaxis

The case history and autopsy findings of a 32-year-old male, who suffered a mild closed-head injury and then had repeated epistaxis beginning 5 months later, is presented. The condition culminated in an episode of fatal epistaxis 1 year after the injury. At one time during the course of his work-up, the etiology of his repeated epistaxis was thought to be a vascular nasopharyngeal neoplasm. The diagnosis of an intracavernous internal carotid artery aneurysm was made only at autopsy. The principles of management of traumatic intracavernous internal carotid artery aneurysm presenting with epistaxis are discussed.     

Treatment of an acute mycotic aneurysm of the common carotid artery with a covered stent-graft

We report herein a case successful endovascular treatment with a stent-graft of a rare case of rapidly growing mycotic aneurysm of the left common carotid artery due to acute bacterial endocarditis after eradication of the infection. Infected mycotic aneurysms of the peripheral vasculature have been considered as a contraindication for stent-graft implantation because of the possibility of microorganism spreading to the stent-graft; however, if there is evidence of complete eradication of microorganism and surgery is not an option, stent-graft implantation can be an effective and safe treatment modality for exclusion of the mycotic aneurysm.     

喉罩对颈总动脉和颈内动脉血流动力学的影响

目的 研究喉罩对颈总动脉(CCA)和颈内动脉(ICA)内径、血流速率和血流量等血流动力学参数的影响.方法 随机选择择期全麻下行腹腔镜胆囊切除术患者60例,为美国麻醉医师协会(ASA)Ⅰ～Ⅲ级.根据不同年龄分为中青年组(A组,20～59岁)和老年组(B组,60～85岁).按不同的喉罩套囊内压力将A组和B组分为4个亚组,即A1、B1(套囊内压为20～30 cm H2O)(1 cm H2O=0.098 kPa)和A2、B2(套囊内压为40～50 cm H2O),每组15例.所有患者术毕后送入ICU复苏,尚未清醒时拔除气管导管,而后置入喉罩.记录置入喉罩前(T0),置入喉罩后3 min(T1)、10 min(T2)和拔除喉罩后(T3)各时点CCA和ICA的内径、血流速率和血流量等血流动力学参数以及生命体征参数.结果 CCA、ICA的内径和CCA血流量的基础值B组比A组要大(P<0.05).与T0比较,在T1和T2时点,A组和B组CCA内径分别减少9.5%～12.9%和14.5%～24.3%(P<0.05或P<0.01),其中以B2组减少最为显著,A2组和B2组ICA内径分别减少10.9%和16.3%(P<0.05).CCA和ICA的血流速率无明显变化(P>0.05).与T0比较,A组和B组,T1和T2时CCA的血流量分别减少9.3%～10.7%和12.2%～19.1%(P<0.05),其中以B2组减少最为显著,A组和B组ICA血流量分别减少10.0%～13.5%和13.9%～16.6%(P<0.05).在T3时点各观察指标均恢复至T0水平.结论 喉罩通气时,CCA和ICA的内径有所缩小,其血流量相应减少,老年患者减少更为明显,而其血流速率则无明显改变.     

盐酸芬戈莫德抑制颈动脉球囊损伤后的血管炎症反应

背景：炎症因子在球囊损伤后血管狭窄的过程中起到关键作用,1型1-磷酸鞘氨醇受体可以增强炎症因子的表达,促进这一病理过程的发生发展。目的：观察大鼠颈动脉球囊损伤后炎症因子及1型1-磷酸鞘氨醇受体的表达变化和盐酸芬戈莫德减轻炎症反应的作用。方法：60只SD大鼠随机分为4组。空白对照组和阴性对照组仅分离左侧颈总动脉,结扎左侧颈外动脉;损伤组和药物干预组行左侧颈总动脉球囊损伤建立大鼠颈动脉损伤模型。阴性对照组与药物干预组以盐酸芬戈莫德1 mg/kg腹腔注射,空白对照组与损伤组用等量生理盐水腹腔注射,于第3,7和21天取材。结果与结论：苏木精-伊红染色显示损伤组血管增生明显,药物干预组血管增生厚度明显减轻,空白对照组与阴性对照组血管形态基本正常。实时荧光定量PCR显示药物干预组第7天环氧合酶2、前列腺素E2 mRNA的表达水平显著低于损伤组(P < 0.05),损伤组和药物干预组环氧合酶2、前列腺素E2 mRNA在同一时间点的表达水平明显高于空白对照组与阴性对照组(P < 0.05);Western Blot显示的结果1型1-磷酸鞘氨醇受体的表达在损伤初期有较高的表达,损伤后期减少,特别是经过药物干预后蛋白表达进一步减少。结果提示盐酸芬戈莫德通过1型1-磷酸鞘氨醇受体调节环氧合酶-2、前列腺素E2mRNA的表达,抑制损伤血管的炎症反应,减轻损伤血管的狭窄。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程全文链接：     

High bifurcation of common carotid artery, anomalous origin of ascending pharyngeal artery and anomalous branching pattern of external carotid artery

We present a rare case of combined high bifurcation of the common carotid artery, anomalous origin of the ascending pharyngeal artery and unusual branching pattern of the external carotid artery. The right common carotid artery bifurcated at the level between the second and the third cervical vertebrae, giving rise to the ascending pharyngeal artery just below the bifurcation. The right external carotid artery branched directly at its origin into the superior thyroid, lingual and occipital arteries and the distal part of the external carotid artery. The latter gave rise to the right facial artery and finally bifurcated into the maxillary and superficial temporal arteries. The right posterior auricular artery arose from the right occipital artery. The finding was unilateral and other vascular anomalies were not observed. The embryogenesis of such a combination of anomalies is not clear, but the anatomic consequences may have important clinical implications.     

构建颈内动脉瘤双向流固耦合模型的血流模拟

背景：动脉瘤血液动力学变化为动脉瘤的治疗与其破裂的预防研究提供了前提与条件,有限元分析是一种很好的技术手段。 目的：构建颈内动脉瘤的双向流固耦合模型,并进行相关血流模拟。 方法：利用GE Lightspeed 64排螺旋CT扫描获得颈内动脉瘤CT血管造影数据,分别在mimics10.01软件上进行三维模型的实体构建,ansys+fluent软件进行流固耦合及血流模拟与仿真。 结果与结论：构建了颈内动脉瘤瘤壁和流场的有限元模型,模型具有良好的解剖形态,并与实体模型一致。模拟展示整个心动周期的血流变化：瘤体血流呈漩涡样,瘤体部流速较瘤颈部慢;血流引起动脉瘤壁的形变、壁面剪切力、压力及应力以瘤颈部最大,瘤顶部最小。模拟值以0.16 s(快速射血期)时刻为最高值,0.74 s(舒张期)为最低值。结果显示基于CT血管造影扫描数据进行颈内动脉瘤的双向流固耦合建模,其方法简单、实用。模拟动脉瘤血流接近人体的生理状态,结果为研究动脉瘤发生、发展提供新的理论依据。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程全文链接：     

Anomalous artery directly connecting the external and internal carotid arteries

An anomalous artery directly connecting the external with the internal carotid artery was encountered on the right side of a 68-year-old Japanese female cadaver. This anomalous artery (5 mm in diameter, 12 mm in length) branched out from the posterior aspect of the external carotid at the level of the origin of the lingual artery, ran obliquely upward posteriorly along the course of the hypoglossal nerve, and was confluent with the anterior aspect of the internal carotid artery. No other variations were found in the morphological aspects of, or in the anatomical relationships between, the carotid arteries and their surrounding structures on either side. The carotid body-like structure was observed at the carotid bifurcation and was innervated by small branches of the glossopharyngeal, the vagus and the sympathetic trunk. Embryologically, it is conceivable that this anomalous artery may have derived from the right second branchial arch artery, although there is no abnormality in other derivative structures of the second pharyngeal arch. There may have been no effect from this anomaly on the functions of the arterial blood flow and blood supply under normal circumstances in the present case, but this report may be of embryological significance and contribute some insight into the mechanisms of the formation of the carotid circulation systems.     

Anatomic evaluation of the carotid artery bifurcation in cadavers: implications for open and endovascular therapy

Knowledge of carotid bifurcation (CB), common carotid artery (CCA) and its branches and their recognition during diagnostic imaging are also important for vascular surgical procedures in the region, such as carotid endarterectomy or radical neck dissection, catheterization and aneurysms. The surgical anatomy of the carotid arteries was studied in 20 cadavers. Micrometric values of the CB and its relation with surrounding structures, measurements belonging to the external carotid artery (ECA) and internal carotid artery (ICA), and metric data, such as lower face including the greater horn, laryngeal prominence have been evaluated by making linear measures. The diameter of the CCA at the CB under 2 cm and CB diameter was measured as 8.1 +/- 2.24 mm and 12.79 +/- 2.87 mm, respectively. Evaluating data related to the ICA and the ECA in samples, the aspect was measured the ICA and the ECA in the CB discrimination point as 21.52 +/- 20.53 degrees . In the most location of the ECA origin according to the ICA has been determined as medial position in 35 specimens. The origin of the superior thyroid artery (STA) was found to be at the same level with the CB in 40% and below it in 25% specimens. This study has provided measured objective criteria for the arterial features of the neck region, which are crucial during surgery. The origins of the branches of the CCA act as key landmarks for adequate and appropriate placement of the cross-clamp on the carotid arteries.     

Anomalous thymic branch of the right common carotid artery

A previously unreported anomalous thymic artery that branched from the anterior aspect of right common carotid artery approximately 1 cm above bifurcation of the brachiocephalic artery was found during routine dissection. It traveled inferiorly through a plexus of inferior thyroid veins for 6 cm in front of the brachiocephalic artery and crossed the anterior surface of the trachea where it divided into two branches that supplied the right and left lobes of the thymus. The development and blood supply of the thymus and their clinical anatomy are reviewed. Clin. Anat. 11:346–348, 1998. © 1998 Wiley-Liss, Inc.     

大鼠颈内动脉的解剖及其在脑缺血模型中的应用

目的研究大鼠颈内动脉的形态,为制作脑缺血再灌注模型提供解剖学依据.方法成年Wistar大鼠20只,先后用墨汁乳胶液混合液灌注、甲醛固定、盐酸溶液浸泡脱钙,去骨取脑.再用XTT型实体显微镜观测颈内动脉的形态、分布.用JC-10型读数显微镜测量颈内动脉主干及其分支的管径.结果颈内动脉长度为17.23±2.1(152-18.8)mm.主要分支有翼腭动脉、大脑后动脉、大脑中动脉和大脑前动脉,后者借交通支与椎-基底动脉系相连.主干及其分支的管径分别是0.71±0.10 mm、0.52±0.056 mm、0.24±0.048 m、0.24±0.04 mm、0.23±0.048mm.结论栓线法制作局灶性脑缺血模型,除了结扎颈总动脉阻断大脑前动脉的血流外,还要避免大脑后动脉的血供,才能提高成功率.     

Thyrolingual trunk arising from the common carotid artery a case report

During a cadaver dissection in the anatomy department of the University of Liege, Belgium, an anatomic variation of the superior thyroid and lingual arteries was observed on the right side in a 68-year-old woman. Both arteries arose from a common trunk located 30 mm beneath the carotid bifurcation. After a 5.2 mm course, the thyrolingual trunk divided into superior thyroid and lingual arteries which followed an unusual course towards their respective organs. Knowledge of this anomaly is important for those who are involved with neck surgery and anatomy.     

颈内动脉海绵窦段分支及分布的显微解剖

目的 :为海绵窦的直接手术提供显微解剖学基础。方法 :采用 48侧成人新鲜海绵窦标本 ,颈内动脉灌注苯乙烯 (ABS) ,然后在手术显微镜下解剖观察。结果 :脑膜垂体干出现率为 10 0 % ,脑膜垂体干可分为两型 ,典型的脑膜垂体干出现率为 5 8.3 % ,非典型的脑膜垂体干又分为单干型和非单干型 ,前者出现率为 3 1.3 % ,后者为 10 .4%。海绵窦下动脉出现率为 95 .8% ,垂体被囊动脉为 3 1.3 %。另外眼动脉的出现率为 10 .4%。两侧颈内动脉海绵窦段分支之间的吻合 ,提供了重要的侧支循环血液供应。结论 :本文对颈内动脉海绵窦段分支的显微解剖结果 ,对临床显微外科、血管介入、影像学有指导意义。     

The diameters of common carotid artery and its branches in newborns

The common carotid artery (CCA) bifurcation is of clinical importance due to its vascular access site for intravascular intervention. Additionally, it is also one of the most common sites of atherosclerotic plaque formation. There are numerous studies on the diameters of CCA, internal carotid artery (ICA), and external carotid artery (ECA) in adults, but few studies on newborns. Cadaver and angiographic studies have shown dimensional variations in the carotid arteries within/between individuals and also between different sexes. It is well known that the initial lesions of atherosclerosis begin very early in fetal life. Therefore, it is important to know the anatomical details of the CCA and its branches. In the present study, the neck regions of 20 (11 males and 9 females) fixed newborn cadavers were dissected. The CCAs were cut below the bulb of the carotid bifurcation further; ICA and ECA were cut above the bulb of the carotid bifurcation. The internal diameters of the CCA, ICA, and ECA were measured using a light microscopy. ECA/CCA, ICA/CCA, ICA/ECA ratios, and outflow to inflow area ratio were calculated. The mean outflow to inflow area ratio was 1.14±0.28. Our results highly correlated with the defined optimal ratio (1.15). The ECA/CCA, ICA/CCA, and ICA/ECA ratios were 0.78±0.12, 0.71±0.13, and 0.93±0.16, respectively. There were no statistically significant differences between male and female and also between right and left sides. These findings are of importance in understanding the anatomy of carotid artery during newborn period.     

Long-term survival of carotid stenting patients with regard to single- or double-vessel carotid artery disease: a propensity score matching analysis

IntroductionThere is lack of long-term data outside of controlled clinical trials in carotid artery stenting (CAS). In this study, we compared the short-term outcome, long-term survival, and rate of re-interventions for restenosis in patients after CAS, related to the extent of carotid atherosclerosis classified as single-vessel (unilateral) or double-vessel (bilateral) carotid artery disease.Material and methodsWe retrospectively evaluated 599 patients with significant carotid artery stenosis, who underwent 763 CAS procedures, and used the propensity score to match 226 pairs (452 patients) in the single- or double-vessel carotid disease.ResultsThere was no significant difference in the occurrence of in-hospital major adverse events (3.5% vs. 3.1% of patients in the double-vessel carotid group vs. the single-vessel carotid group; p = 1) The mean follow-up was 6.1 ±4.0 years, and a total of 181 (40%) deaths occurred during 2759 patient-years, which translates into 7.8 and 5.3 deaths per 100 patient-years in the double-vessel carotid group and the single-vessel carotid group, respectively (p < 0.01). The survival in the double-vessel carotid group vs. the single-vessel carotid group at 10 years was 46% (95% CI: 38–54%) vs. 55% (95% CI: 47–63%) (p < 0.01). Twenty-four (11%) patients and 6 (3%) patients underwent re-interventions for restenosis in the double-vessel and the single-vessel carotid disease group, respectively (p < 0.01).ConclusionsPatients with CAS and significant double-vessel carotid artery disease had similar peri-procedural risk, but had a worse long-term survival, and a higher rate of re-interventions for restenosis compared to the single-vessel carotid artery disease patients.     

Anastomosis between the internal carotid and vertebral artery in the neck

Summary We report a case of anastomosis between the internal carotid and vertebral a. in the cervical region. This anatomic variation is due to incomplete migration during embryogenesis of the branchial aa., collaterals of the dorsal aorta, towards the ventral aorta. It does not involve persistence of a type I proatlantal a., as described by Lasjaunias. Such anastomoses must be recognised since they may modify surgical tactics in the context of endarterectomy for carotid stenosis.

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Anastomose entre l'artère carotide interne et l'artère vertébrale à l'étage cervical

Résumé Nous rapportons un cas d'anastomose entre l'artère carotide interne et l'artère vertébrale à l'étage cervical. Cette variation anatomique est due à la migration incomplète, au cours de l'embryogénèse, des artères branchiales, collatérales de l'aorte dorsale, vers l'aorte ventrale. Il ne s'agit pas de la persistance d'une artère proatlantale type I comme l'avait décrit Lasjaunias. De telles anastomoses doivent être reconnues et peuvent modifier la tactique chirurgicale dans le cadre des endartériectomies de sténoses carotidiennes.