Bilateral Carotid Angiography Research Articles

Radiological evaluation of middle meningeal artery by 3D rotational angiography.

This study aimed to evaluate the topographic features and branches of the middle meningeal artery (MMA) by three-dimensional rotational angiography (3DRA) and describe its variations' radiological classification based on previous clinical examples of cadaver studies and literature. We consecutively evaluated 87 cerebral hemispheres, including 32 females and 49 right sides between May 2020 and December 2021 who had undergone unilateral or bilateral cerebral and carotid artery 3D rotational angiography imaging by CCA injection and between 18 and 76-years-old. Maximum intensity projection images with 10-30 mm slice thickness were used for the morphological evaluations and measurements of MMA and its foramen, canal, and branches. The diameters of the common carotid artery, internal carotid artery, and external carotid artery were significantly smaller in females than in men (p = 0.021, 0.021, and <0.001, respectively). According to the branching pattern, the most common pattern of the MMA was Type Ia (49.4%). The ophthalmic artery completely originated from MMA in the 1 (1.1%) cerebral hemisphere. The MMA arises from the ophthalmic artery in 2 cerebral hemispheres (2.3%), and the ophthalmic artery and maxillary artery in 2 cerebral hemispheres (2.3%). It was observed that the branching pattern may show differences when compared to the cadaver studies with a radiologic evaluation with 3D-RA.

Intracranial aneurysms - a battle against time

Introduction: Intracranial aneurysms consist in abnormal dilatation of the cerebral arteries, most frequently asymptomatic, with symptoms appearing in the case of aneurysm rupture. From an imaging point of view, a cranial CT scan shows the subarachnoid haemorrhage caused by aneurysm rupture and the “gold standard” for aneurysm diagnosis is cerebral angiography.&#x0D; Case presentation: A 49 years-old female, Ukrainian refugee, presented with a unique comitial crisis and chronic headache. Following an MRI performed in Kiev, it was decided to perform a bilateral carotid and vertebral angiography in our clinic. Clinical and imagistic results showed a giant left middle cerebral artery aneurysm. Postoperative, the patient had a favourable neurological recovery, with no neurological deficits. Additionally, control angiography and CT scan highlight complete occlusion of the aneurysm and no complications.&#x0D; Conclusions: Cerebral aneurysms represent a high-risk vascular condition that needs a CT scan and angiography to be precisely diagnosed, surgical clipping should be performed as soon as possible.

Alternate Simultaneous Bilateral Carotid Angiography in Y-stent−Assisted Coil Embolization for an Anterior Communicating Artery Aneurysm with Triplicate A2 Variant

The triplicate A2 variant is one of several common anomalies of the anterior cerebral artery. An anterior communicating artery aneurysm with triplicate A2 variant in close proximity to the aneurysm neck is challenging to treat due to potential unilateral/bilateral corpus callosum or parietal lobe infarction. Alternate simultaneous bilateral carotid angiography can differentiate triplicate A2 branches through time-difference alternate injection of contrast into the carotid arteries bilaterally, which can enhance anatomic understanding of complex anterior communicating artery aneurysms during complex endovascular treatment. In this case, a complex aneurysm with an associated triplicate A2 variant was treated successfully with Y-stent-assisted coil embolization using alternate simultaneous bilateral carotid angiography.

Endovascular therapy for posterior communicating artery-infundibular dilatation aneurysms

Objective: The purpose of this study was to explore the effect of endovascular therapy on posterior communicating artery-infundibular dilatation aneurysms. Methods: A total of 15 patients with ruptured aneurysms caused by posterior communicating artery-infundibular dilatation who were treated in our neurosurgical center from January 2015 to December 2018were included in this study. They were performed with bilateral internal carotid angiography and vertebral angiography and treated with endovascular method. The modified Rankin Scale (mRS) was used for clinical follow-up for 18 months. Results: There were 10 patients in the posterior communicating artery-infundibular dilatation aneurysms with non-fetal posterior cerebral artery. Among them, 8 patients were treated with coil-alone embolization. Immediate imaging showed infundibular dilation residual in 6 cases and no contrast filling in either infundibular dilation or aneurysm in 2 case. Another 2 were treated with stent-assisted coiling embolization, and immediate imaging showed no contrast filling. Of the 5 patients in posterior communicating artery-infundibular dilatation aneurysms with fetal posterior cerebral artery, 4 were only coiled in the aneurysm sack with contrast filling in infundibular cones, and 2 were treated with stent assisted coiling. Among the 10 patients with non-fetal posterior cerebral artery, 3 showed recurrence, 4 showed stable images, 2 were also stable with no contrast filling in infundibular dilation or aneurysm and 1 was lost to follow-up. Among the 5 patients with fetal posterior cerebral artery, 1 showed stable images, 3 showed recurrence and 1 was lost to follow-up. Conclusions: For posterior communicating artery-infundibular dilatation aneurysms with non-fetal posterior cerebral artery, stent-assisted coiling of aneurysm embolization combined with occlusion of cones is effective to prevent or reduce recurrence.

Preoperative angiography and external carotid artery embolization of juvenile nasopharyngeal angiofibromas in a tertiary referral paediatric centre

To evaluate the relationship between intraoperative blood loss and juvenile nasopharyngeal angiofibroma (JNA) vascular supply and tumour stage in patients who underwent superselective external carotid artery (ECA) embolization. This series is unique in that all embolizations were performed by dedicated paediatric interventional radiologists at a tertiary referral paediatric centre. Seventeen male patients treated from January 2002 to August 2009 underwent preoperative angiography and embolization using polyvinyl alcohol (PVA) particles. Tumours were graded using three different staging systems based on preoperative imaging and correlated to surgical blood loss. All patients underwent bilateral internal and external carotid angiography, with embolization of ECA tumour supply via microcatheter delivery of PVA particles. Particle size ranged from 150-500μm with a mean size of 250-355μm. Surgical resection was performed with either endoscopic or open techniques within 24h and intraoperative blood loss was reported. Seven lesions were supplied strictly by the ECA circulation and had mean surgical blood loss of 336ml. Twelve lesions had both ECA and internal carotid artery (ICA) supply and had mean surgical blood loss of 842ml. The difference in blood loss in these two groups was statistically significant (p=0.03). There was no case of inadvertent intracranial or ophthalmic embolization. There were statistically significant correlations between estimated surgical blood loss and the Andrews (p=0.008), Radkowski (p=0.015), and University of Pittsburgh Medical Center (UPMC; p=0.015) preoperative tumour staging systems, respectively. Preoperative embolization of JNA tumours can be safely performed without neurological complications. The present study identified a statistically significant difference in intraoperative blood loss between those lesions with a purely ECA vascular supply and a combination of ECA and ICA vascular supply. Angiography is helpful in delineating ICA supply and can help guide surgical planning.

Transcardiac cerebral angiography in a child

The authors present a case in which transfemoral venous, transcardiac cerebral angiography was performed. In this 5-year-old girl with PHACE syndrome, both transfemoral and transbrachial arterial routes could not be used due to aortic interruption and aneurysmal dilation and small looping of the proximal portion of bilateral subclavian arteries. A 5-F balloon-tipped double-lumen catheter was advanced to the right atrium of the heart from the femoral vein. The catheter was then advanced to the left atrium through the patent foramen ovale and was further advanced to the left ventricle and then to the ascending aorta. The balloon catheter was exchanged for a 4-F catheter. Bilateral common carotid angiography was performed without difficulty. This transcardiac approach is useful in the unusual situation in which both femoral and brachial arterial routes are not available.

E-005 Super-selective pre-operative embolization of juvenile angiofibromas

PurposeJuvenile angiofibromas (JNAs) are hypervascular, locally destructive tumors best treated by complete surgical resection. They occur predominantly in teenage boys and originate at the posterior pedicle of the middle turbinate...

The Efficacy of Simultaneous Bilateral Internal Carotid Angiography during Coil Embolization for Anterior Communicating Artery Aneurysms

Successful coil embolization of anterior communicating (A-com) artery aneurysms requires good visualization and understanding of the entire H complex. Bilateral carotid angiography may optimize anatomical understanding and visualization of the H complex. We therefore assessed the efficacy of simultaneous bilateral internal carotid angiography during coil embolization for A-com artery aneurysms. Of the 153 patients with intracranial saccular aneurysms who underwent embolization between July 2008 and December 2009, 12 had A-com artery aneurysms and were embolized under bilateral carotid angiography. Patients were evaluated angiographically, immediately and 6 months (n=11) after embolization, using a 3-point scale (complete, residual neck, residual aneurysm). The safety, performance and efficacy of this approach were retrospectively evaluated. In all patients, bilateral internal carotid artery angiography provided more detailed anatomical information and understanding around the A-com artery, and, in complex situations, it allowed for more effective coil embolization through bilateral routes to the A-com artery. Angiography immediately after embolization showed occlusion of 11 of the 12 (92%) aneurysms, with none of these 11 showing evidence of recanalization at 6 months. These findings indicate that simultaneous bilateral carotid angiography during coil embolization of selected complex A-com artery aneurysms provided improved anatomical understanding, and resulted in more effective and safer procedures than typical unilateral angiography.

Paragangliomas of the Head & Neck: the KMC experience.

To determine the clinical features, investigations, intra-operative findings, surgical approaches used and the results of the treatment for paragangliomas of the head and neck. Retrospective study of 14 cases of paragangliomas in head and neck seen over a period of 10 years including five carotid body tumors, seven glomus jugulares and two glomus tympanicums. HRCT scans and bilateral carotid angiography were done in all cases of glomus jugulare. Pre-operative embolization was done in most cases. The trans-cervical approach was used for all cases of carotid body. In three cases of Type B jugulare tumors, a post-aural tympanotomy was used. A Fisch Type A approach was done for three cases of Type D jugulare tumors. Postaural tympanotomy approach was used for both patients with glomus tympanicum. In one case of extratympanic glomus jugulare tumor with hypoglossal palsy, a neck exploration was done to isolate and excise the tumor. Five patients with carotid body tumors presented as unilateral, painless, pulsatile swelling in the upper neck. Intra-operatively, three of the tumors were classified into Shamlin's Grade II and one each into Grade III and Grade I. A carotid blow-out occurred in one of the patients with Grade II disease, which was managed. ECA resection had to be done in one case. Seven patients were diagnosed to have glomus jugulare and two with glomus tympanicum. Six glomus jugulare tumors presented with hearing loss, ear discharge and obvious swelling. Glomus tympanicums presented with hearing loss but no bleeding from the ear. On examination, tumors presented with an aural polyp with no VII nerve deficits. Both tympanicums were classified as Fisch Type A, three of the jugulares classified as Type B, two as Type D2 and one as Type D1. Tumors were found to be supplied predominantly by the ascending pharyngeal artery. In three cases of Type B jugulare tumors, a post-aural tympanotomy was used. A Fisch Type A approach was done for three cases of Type D jugulare. The transcanal approach was used for both patients with glomus tympanicum. Paragangliomas are uncommon tumors that need accurate diagnosis and skilled operative techniques. Though the surgical approaches may appear complicated, the removal provides good cure rates with minimal morbidity and recurrence. Lateral skull base approaches should be the armamentarium of every head and neck surgeon.

Importance of cerebral pan-angiography for detection of multiple aneurysms in patients with aneurysmal subarachnoid haemorrhage.

In the Danish Aneurysm Study 948 patients had a ruptured intracranial aneurysm (RA) revealed by cerebral angiography. Unilateral carotid angiography (UCA) with or without vertebral angiography (VA) demonstrated the RA in 206 patients, and 16 (7.8%) unruptured aneurysms (UA) were disclosed by UCA and 1 UA by VA. In 740 patients with at least bilateral carotid angiography (BCA) 164 UA (22.2%) were disclosed by BCA and 10 by VA. I.e. the number of UA demonstrated in patients with RA is not only doubled by BCA compared to ipsilateral UCA, but tripled demonstrating that an additional UA is more likely situated on the opposite side of the RA. Pan-angiography (or at least BCA) is therefore recommended in patients with RA.

Changes in Internal Carotid Blood Flow after CEA Evaluated by Transit-time Flowmeter

Aim The aim of this study was to investigate whether there was an association between the degree of the stenosis of the internal carotid artery (ICA) and post-operative increase of blood flow. Methods and materials In 200 out of 660 patients undergoing carotid endarteriectomy (CEA) for a high-degree ICA stenosis, pre-operatively a bilateral selective carotid and intracerebral angiography was performed. The degree of the ipsilateral and contralateral stenosis was digitally assessed by using computer software according to the CC-Index. Intraoperatively, the pressure ratio over the stenosis (ICA/CCA) was measured by direct arterial puncture. Blood flow in the ICA was measured before and after CEA with an ultrasound flowmeter using the transit-time principle. These findings were correlated to the degree of stenosis revealed by angiographic analysis and the pressure ratio. Results Before CEA the median blood flow in the ICA was 171 ml/min (range 620 ml/min) with a significant ( p<0.001) post-operative increase to 250 ml/min (range 875 ml/min). The median relative increase of flow (post-flow–pre-flow/pre-flow) was 42%. The pre-CEA flow volumes were dependent on the degree of stenosis and also the pressure ratio. The increase of flow following CEA correlated better with pressure ratio ( r=−0.435, p<0.001), than the stenosis severity ( r=0.319, p<0.001). Analysis of variance identified only the pressure gradient as an independent determinant of flow changes following CEA. Conclusions The blood flow increase following CEA is mainly determined by the pressure gradient across the stenosis.

Combined endovascular and surgical treatment of head and neck paragangliomas—A team approach

Background Paragangliomas are highly vascular tumors of neural crest origin that involve the walls of blood vessels or specific nerves within the head and neck. They may be multicentric, and they are rarely malignant. Surgery is the preferred treatment, and these tumors frequently extend to the skull base. There has been controversy concerning the role of preoperative angiography and embolization of these tumors and the benefits that these procedures offer in the evaluation and management of paragangliomas. Methods Forty-seven patients with 53 paragangliomas were treated from the period of 1990–2000. Initial evaluation usually included CT and/or MRI. All patients underwent bilateral carotid angiography, embolization of the tumor nidus, and cerebral angiography to define the patency of the circle of Willis. Carotid occlusion studies were performed with the patient under neuroleptic anesthesia when indicated. The tumors were excised within 48 hours of embolization. Results Carotid body tumors represented the most common paraganglioma, accounting for 28 tumors (53%). All patients underwent angiography and embolization with six patients (13%), demonstrating complications (three of these patients had embolized tumor involving the affected nerves). Cerebral angiography was performed in 28 patients, and 5 of these patients underwent and tolerated carotid occlusion studies. The range of mean blood loss according to tumor type was 450 to 517 mL. Postoperative cranial nerve dysfunction depended on the tumor type resected. Carotid body tumor surgery frequently required sympathetic chain resection (21%), with jugular and vagal paraganglioma removal frequently resulting in lower cranial nerve resection. These patients required various modes of postoperative rehabilitation, especially vocal cord medialization and swallowing therapy. Conclusions The combined endovascular and surgical treatment of paragangliomas is acceptably safe and effective for treating these highly vascular neoplasms. Adequate resection may often require sacrifice of one or more cranial nerves, and appropriate rehabilitation is important in the treatment regimen. © 2002 Wiley Periodicals, Inc.

Combined endovascular and surgical treatment of head and neck paragangliomas--a team approach.

Paragangliomas are highly vascular tumors of neural crest origin that involve the walls of blood vessels or specific nerves within the head and neck. They may be multicentric, and they are rarely malignant. Surgery is the preferred treatment, and these tumors frequently extend to the skull base. There has been controversy concerning the role of preoperative angiography and embolization of these tumors and the benefits that these procedures offer in the evaluation and management of paragangliomas. Forty-seven patients with 53 paragangliomas were treated from the period of 1990-2000. Initial evaluation usually included CT and/or MRI. All patients underwent bilateral carotid angiography, embolization of the tumor nidus, and cerebral angiography to define the patency of the circle of Willis. Carotid occlusion studies were performed with the patient under neuroleptic anesthesia when indicated. The tumors were excised within 48 hours of embolization. Carotid body tumors represented the most common paraganglioma, accounting for 28 tumors (53%). All patients underwent angiography and embolization with six patients (13%), demonstrating complications (three of these patients had embolized tumor involving the affected nerves). Cerebral angiography was performed in 28 patients, and 5 of these patients underwent and tolerated carotid occlusion studies. The range of mean blood loss according to tumor type was 450 to 517 mL. Postoperative cranial nerve dysfunction depended on the tumor type resected. Carotid body tumor surgery frequently required sympathetic chain resection (21%), with jugular and vagal paraganglioma removal frequently resulting in lower cranial nerve resection. These patients required various modes of postoperative rehabilitation, especially vocal cord medialization and swallowing therapy. The combined endovascular and surgical treatment of paragangliomas is acceptably safe and effective for treating these highly vascular neoplasms. Adequate resection may often require sacrifice of one or more cranial nerves, and appropriate rehabilitation is important in the treatment regimen.

Outpatient Cardiac Catheterization and Angiography: Safety and Experience with Transradial Approach

Background and Objectives:The safety and efficacy of outpatient cardiac catheterization was established.4 We evaluated our patient population and complications selected for outpatient procedures and our experience with transradial approach. Materials and Methods:A total of 346 outpatient cardiac catheterization (31% of all diagnostic procedures), performed with transradial approach, was compared with 788 inpatient diagnostic pr-ocedures in terms of patient population, clinical and angiographic features, complications of examinations. Results:1) Indications of outpatient coronary angiography were as follows;follow-up of coronary interventions or bypass surgery (41.6%), recent-onset or aggravated angina (31.2%), atypical chest pain (19.4%), stable angina (3.8%), recent myocardial infarction (2.9%), variant angina (0.9%), preoperative evaluation of valvular or congenital heart disease (0.3%). 2) Significant coronary lesions were found in 216 (62.5%) patients and left main disease in 12 (3.5%). Coronary spasm test, internal mammary artery or saphenous vein graft angiography, aorto-ileofemoral angiography, and bilateral carotid angiography were safely performed as indicated. 3) Success rate of examination by primary approach was 94.5%, similar to 94.9% of inpatients. Alternative brachial or femoral approaches were needed in 19 (5.5%) patients. 4) No death, cerebral thromboembolism or myocardial infarction were observed and one-day admission was required in 13 (3.7%) patients. Initial 254 patients (33%) showed good radial pulse (94%), weak or absent radial pulse (6%), abnormal reverse Allen test (6%) up to 61±25 days. However, no claudication was observed. Conclusion:Cardiac catheterization and angiography was safely performed in the outpatient population selected using much extended inclusion criteria. Transradial approach is useful to set up outpatient procedures with 논문접수일:1999년 3월 18일 심사완료일:1999년 9 월 1일 교신저자:차광수, 602-715 부산광역시 서구 동대신동 3가 1 동아대학교 의과대학 내과학교실 전화:(051) 240-5620·전송:(051) 242-1449 E-mail:happy@damc.dauosp.or.kr

The effect of oestrogen on the development of arteriovenous fistulae induced by venous hypertension in rats.

Dural arteriovenous fistulae (AVF) represent abnormal communication between the meningeal arteries and the dural sinuses. Clinically, this condition appears more frequently in post-menopausal and pregnant women than in the general population. Oestrogen is believed to play an important role in the development of dural AVF; however, its exact role has not been clearly defined. We have previously reported that by surgically creating a carotid-jugular shunt in male rats, which then induces venous hypertension, spontaneous arteriovenous fistulae can result. To examine the specific role that oestrogen may have in the development of AVF induced by venous hypertension, we performed the following experimental procedure. Ninety-four Sprague-Dawley female rats (250-300 grams in weight) were randomly assigned to four different groups. Group 1 (n = 20): control (bilateral ovariectomy only). Group 2 (n = 19): bilateral ovariectomy and implantation of the oestrogen pellet (17-beta oestradiol 0.75 mg/pellet, 60 days release). Group 3 (n = 17): bilateral ovariectomy and venous hypertension (left carotid-jugular shunt with proximal jugular vein occlusion). Group 4 (n = 38): bilateral ovariectomy and oestrogen pellet implantation and venous hypertension. All of the groups were examined by angiography 60 days after treatment. In Groups 1 and 2, bilateral common carotid angiography was performed via a transfemoral route. In Groups 3 and 4, angiography was done after surgical ligation of the carotid-jugular shunt to examine for any newly developed AVF. No newly developed AVF were found in either Groups 1, 2, or 3. In Group 4, 2 rats (5.3%) developed newly formed AVF which occurred in the nose and neck. Our previous study demonstrated that AVF appeared in 3 of 22 (13.6%) venous hypertensive male rats. Therefore, no statistical difference in the appearance rate of newly formed AVF was found among groups 1, 2, 3 or 4 and between our previously reported group of male venous hypertensive rats. In this experimental study, ovariectomy with or without oestrogen did not affect the development of spontaneous AVF induced by venous hypertension.

Transseptal approach to aortography and carotid artery stenting in pulseless disease

We report on a patient with pulseless disease (Takayasu's arteritis) in whom access to the central circulation by extremity arterial cannulation was not possible due to absent pulses in all four limbs. The transseptal approach was used for aortography, bilateral selective carotid angiography, and successful elective stent deployment in the right common carotid artery. Cathet. Cardiovasc. Diagn. 40:416–420, 1997. © 1997 Wiley-Liss, Inc.

Surgical Management of Bilateral Familial Form of a Carotid Body Tumor

A patient with bilateral carotid body tumor who underwent a two-stage operation is presented. Diagnosis is based on bilateral selective carotid angiography. On the right side resection was easy, but on the left side, the internal carotid artery and hypoglossal nerve were resected, together with the tumor, and a reversed saphenous vein graft was used to permit the continuity of the internal carotid artery. Hypoglossal nerve reconstruction was done by a neurosurgery team.

Evaluation by angiography of the lateral dominance of the drainage of the dural venous sinuses.

Venous drainage dominance of the dural venous sinuses may be defined as the drainage only or mainly into one of the transverse sinuses, as shown by bilateral carotid angiography. The aim of this study was to evaluate the venous drainage dominance in bilateral carotid angiograms of 189 cases retrospectively. Among these cases 41.3% showed drainage mainly to the right side, 37.6% showed equal drainage to each side, 18.5% showed drainage mainly to the left side, 2.1% showed drainage only to the right side and 0.53% showed drainage only to the left side. Cerebral venous drainage dominance is of great importance and should be considered before operations on patients for radical neck dissection, removal of tumors in the neck that invade the internal jugular vein or tumors of the glomus jugulare which may require ligation of the internal jugular vein.

Hémiplégie posttraumatique sur dysplasie fibromusculaire carotidienne

A 44-year-old patient, without remarkable medical history, was admitted with a head trauma with initial loss of consciousness and a thoracic trauma. The initial treatment included the insertion of a chest drain for evacuation of a pneumothorax and intrapleural analgesia with bupivacaine. The day after admission, the patient experienced a generalized epileptic crisis, without prodomes. Later, a left proportional hemiplegia with aphasia was recognized. The CT scan obtained immediately after the crisis, as well as the carotid Doppler ultrasonography and echocardiography were normal. The bilateral carotid angiography showed an image of fibromuscular dysplasia of the extracranial segment of the right internal carotid artery. The migration of a carotid thrombus initiated by the trauma was hypothetized. A treatment with a platelet aggregation inhibiting drug was started and associated 20 days later with low molecular weight heparin. The patient recovered a normal motility within 10 days ; only the aphasia remained. Trauma of the carotid artery is not a frequent cause of cerebrovascular accident. The occurrence of the latter is favoured by a pre-existing lesion of this artery. This case demonstrates that in a trauma patient not all central nervous system manifestations are initiated by a head trauma.

Effect of unilateral pre- and postganglionic lesioning of the trigeminal nerve on the development of cerebral vasospasm in the squirrel monkey: angiographic findings.

Bilateral carotid angiography was performed in the squirrel monkey before and after unilateral pre- and postganglionic trigeminal lesioning. A unilateral postganglionic lesion caused a significant constriction of about 27% of the ipsilateral cerebral arteries, while a preganglionic lesion did not change the baseline arterial diameter. Following a subarachnoid haemorrhage (SAH) the degree of vasoconstriction in the animals with a preganglionic lesion did not differ significantly from that seen in controls. In the postganglionically lesioned animals, the vasoconstriction was more pronounced (12% at both 10 min and 6 days post SAH) on the lesioned as compared with the non-lesioned side. At day 6 post SAH the degree of vasoconstriction was 19% more pronounced on the lesioned side in post- as compared with the preganglionically lesioned animals. There was no difference in the degree of spasm on the non-lesioned side between the two groups. The findings indicate that the trigeminal system has both a peripheral and a central function. The peripheral, or axon reflex mechanism, exerts a tonic effect on the cerebral vessels. Following a SAH the axon reflex seems to attenuate cerebral vasospasm.