Head and neck CT angiography to assess the internal carotid artery stealing pathway

Dongxu Wang,Yuguang Wang,Jun He,Zheng Li,Zhenghua Wang,Tianyu Zhang,Houyi Cong,Xiaoyang Zheng

doi:10.1186/s12883-020-01915-w

Abstract

BackgroundCommon carotid artery occlusive disease (CCAOD) could form internal carotid artery steal pathways. Based on the diagnostic results of digital subtraction angiography (DSA), head and neck computed tomography angiography (CTA) was used to find the internal carotid artery stealing pathway after CCAOD.Methods: The clinical and imaging data of 18 patients with CCAOD were retrospectively analyzed. DSA and CTA was used to evaluate internal carotid artery steal pathways.ResultsOf the 18 patients with CCAOD, 10 patients found internal carotid artery steal pathways. There were 7 males and 3 females. Vascular ultrasound examination of all patients: The affected side had no blood flow in common carotid artery (CCA), and had retrograde blood flow in the external carotid artery (ECA). The blood flow of the affected side was decreased in the internal carotid artery (ICA), but it was antegrade. DSA diagnosed 10 cases of CCA occlusion and CTA diagnosed 10 cases of CCA occlusion. DSA and CTA found 6 internal carotid artery blood stealing pathways: ① Vertebral artery → occipital artery → external carotid artery → internal carotid artery (6 cases); ② Thyrocervical trunk → ascending cervical artery → occipital artery → external carotid artery → internal carotid artery (7 cases); ③ Costocervical trunk → deep cervical artery → occipital artery → external carotid artery → internal carotid artery (6 cases); ④ Affected side thyroid neck trunk → inferior thyroid artery → superior thyroid artery → external carotid artery → internal carotid artery (2 cases); ⑤ Contralateral external carotid artery → contralateral superior thyroid artery → affected superior thyroid artery → external carotid artery → neck Internal artery (2 cases); ⑥ Parathyroid neck → superficial cervical artery → occipital artery → external carotid artery → internal carotid artery (1 case).ConclusionsThe patients with CCAOD can find the internal carotid artery blood stealing pathway through CTA.

Highlights

Common carotid artery occlusive disease (CCAOD) could form internal carotid artery steal pathways
18 CCAOD patients accounted for 0.39% of patients with ischemic stroke, of which 10 patients had internal carotid blood stealing (Table 1)
The blood flow of the affected side was decreased in the internal carotid artery (ICA), but it was antegrade

Summary

Introduction

Common carotid artery occlusive disease (CCAOD) could form internal carotid artery steal pathways. Based on the diagnostic results of digital subtraction angiography (DSA), head and neck computed tomography angiography (CTA) was used to find the internal carotid artery stealing pathway after CCAOD. DSA and CTA was used to evaluate internal carotid artery steal pathways. Common carotid artery occlusive disease (CCAOD) refers to severe stenosis (stenosis ≥80%), sub occlusion (stenosis ≥95%) and occlusion caused by various causes, which can cause ischemic stroke [1]. Cerebral blood flow compensation is more complicated with CCAOD. The direction of blood flow in the artery is reversed, which is called “internal carotid artery steal” [2, 3]. The assessment of collateral circulation pathways in ischemic stroke is currently being actively studied.

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Conclusion