Cervical Artery Research Articles

Abstract 133: Over Estimation Of Percent Stenosis By Physician Operators May Lead To Carotid Stent Over Utilization

Introduction: Based largely on the inclusion criteria of clinical trials, the degree of cervical carotid artery stenosis is often used as an indication for stent placement in the setting of carotid atherosclerotic disease. However, the rigor and consistency with which such stenosis is measured outside of clinical trials is unclear. We compared the percent stenosis as measured by real world physician operators to that measured by independent expert reviewers. Hypothesis: We hypothesized that the documented degree of stenosis, termed operator-reported stenosis (ORS), from real world facilities performing carotid stent placement would be larger than the reviewer-measured stenosis (RMS) as assessed by clinicians experienced in treating carotid artery disease. Methods: Images were selected from patient cases used for carotid stenting facility accreditation. Data collected included demographics, National Institutes of Health Stroke Scale, modified Rankin Score, and the documented degree of stenosis (ORS). The ORS was compared to the RMS, derived from a panel of expert clinicians. Results: A total of 68 angiograms were reviewed from 39 symptomatic and 29 asymptomatic patients. The RMS values demonstrated excellent agreement with an intra-class correlation of 0.80. The median ORS was 90.0% (IQR 80.0, 90.0) versus a median RMS of 61.1% (IQR 49.8, 73.6), with a median difference of 21.8% (IQR 13.7, 34.4), p < 0.001. This discrepancy persisted within several subpopulations and was larger among asymptomatic patients and those treated at facilities granted delayed accreditation. Based on RMS values, 72% of symptomatic patients and only 10% of asymptomatic patients would meet the Centers for Medicare and Medicaid Services criteria for carotid stent placement. Conclusions: Real world operators tend to overestimate cervical carotid artery stenosis compared to external expert reviewers. Since decisions regarding carotid revascularization are often based at least partially on percent stenosis, such measuring discrepancies inevitably lead to a higher volume of procedures, which may in turn represent a degree of procedural over utilization.

Abstract WP142: Risk Of New Ischemic Events In Patients With Symptomatic Internal Carotid Artery Stenosis While Awaiting Carotid Artery Stent Placement

Introduction: Although there is emphasis on performing carotid artery stent placement (CAS) within two weeks after index event of transient ischemic attack (TIA) or minor stroke in patients with cervical internal carotid artery (ICA) stenosis, the risk and characteristics of recurrent cerebral ischemic events while waiting for CAS are not well defined. Method: We analyzed patients admitted to our institution over a 45-month period with symptomatic cervical ICA stenosis. All patients were initiated on daily aspirin and clopidogrel 75mg on the day of admission. We identified any new cerebral ischemic events that occurred between index event and CAS and categorized them as TIA, and minor or major ischemic strokes. We calculated the risk of new ipsilateral cerebral ischemic events between index ischemic event and CAS. Results: The mean age of 150 patients analyzed was 67 years (range: 46-94 years; 106 were men); and 94 and 56 patients had ≥ 70% and 50-69% stenosis, respectively. The mean and median time intervals between index event and CAS performance were 25 and 6 days, respectively. A total of 6 new cerebral ischemic events (5 TIAs and 1 major stroke) were observed over 3,776 patient days of observation. The risk of new ipsilateral cerebral ischemic events between index ischemic event and CAS performance was 1.6 per 1000 patient days of observation. Conclucion: We identified a low risk of new ipsilateral cerebral ischemic events in patients with ≥ 50% ICA stenosis while waiting for CAS presumably due to early initiation of dual antiplatelets.

Total arch replacement with extended branched stented anastomosis frozen elephant trunk repair for type A dissection improves operative outcome.

Emergency surgical repair is the standard treatment for acute aortic dissection type A. However, the surgical risk of total arch replacement remains high. The Viabahn Open Revascularization TEChnique has been used for supra-aortic reconstruction during total arch replacement. This Cleveland Clinic technique is called "branched stented anastomosis frozen elephant trunk repair." Our total arch replacement with reconstructed extended branched stented anastomosis frozen elephant trunk repair requires no unnecessary cervical artery exposure. We compared the outcomes of extended branched stented anastomosis frozen elephant trunk repair and conventional total arch replacement in acute aortic dissection type A. We compared the clinical course of patients undergoing total arch replacement using sutureless direct branch vessel stent grafting with frozen elephant trunk (extended branched stented anastomosis frozen elephant trunk repair) for acute aortic dissection type A with patients undergoing conventional total arch replacement. For the procedure, the aortic arch was transected circumferentially distal to the brachiocephalic artery origin. Frozen elephant trunk was fenestrated by heating with a cautery, and the self-expandable stent graft was delivered into the branch vessels through the fenestration. Of 58 cases, 21 and 37 were classified in the extended branched stented anastomosis frozen elephant trunk repair and conventional total arch replacement groups, respectively. The times (minutes) of selective antegrade cerebral perfusion (75±24, 118±47), total operation (313±83, 470±151), and cardiopulmonary bypass (195±46, 277±96) were significantly better in the extended branched stented anastomosis frozen elephant trunk repair group (P<.001). Six surgical deaths occurred: 2 (9%) in the extended branched stented anastomosis frozen elephant trunk repair group and 4 (10%) in the conventional total arch replacement group. In all cases, only 1 patient (2%) in the conventional total arch replacement group had a branch artery-related complication during the postoperative follow-up period. In the extended branched stented anastomosis frozen elephant trunk repair group, blood product use significantly decreased (P<.05). Extended branched stented anastomosis frozen elephant trunk repair has shown comparable safety and efficacy to conventional total arch replacement and can be used for acute aortic dissection type A emergency repair. It optimizes true lumen perfusion and facilitates supra-aortic artery remodeling.

Abstract WP139: Current Practice Trends In The Management Of Cervical Artery Dissection - Preliminary Results

Introduction: Cervical artery dissection (CAD) is a well-recognized cause of acute ischemic stroke, especially in young adults, accounting for up to 20-25% of all cases. Several studies reported an incidence between 2.5-5 per 100,000 in the general population. However, the actual incidence may be higher as many patients remain asymptomatic. Even though CAD is one of the leading causes of ischemic stroke, there is a lack of consensus in management. Our study surveyed practicing clinicians involved in the management of CAD to characterize current practice trends and provide a foundation for future research. Methods: An online case-based questionnaire with 11 questions regarding the management of cervical artery dissection was developed and piloted internally with 12 Mayo Clinic cerebrovascular neurologist/neurosurgeons. The survey was finalized, and initially sent to the STOP-CAD study group. We then sent the survey to practicing vascular neurologists across different academic institutions. Surveys were sent to 126 unique individuals. Results: A total of 42 clinicians completed the questionnaires. The response rate was 33% (42/126). Aspirin antiplatelet monotherapy was seen as the most appropriate therapy for asymptomatic CAD (81% [34/42]). Anticoagulation was the treatment of choice for cases with CAD and concomitant intraluminal thrombus (74% [31/42]). Most (74% [31/42]) of the participants recommended repeat imaging at three months. However, no consistent response regarding the type of antithrombotic agent for symptomatic CAD without intramural thrombus or cases with pseudoaneurysm. There was marked variability regarding the duration of antithrombotic therapy, ranging from three months to life-long treatment. Conclusion: Marked variability was seen in the management of CAD, especially regarding the choice of antithrombotic agent in symptomatic and complicated (stenosis or pseudoaneurysm) cases and the duration of such therapy, which reflects the lack of definitive clinical trial data. Ongoing research is needed to better guide the optimal management of these patients.

Abstract WP175: Cardiovascular And Cerebrovascular Disease Risk Assessment Amongst Patients With Status Migrainosus And Migraine With Aura - A Nationwide Study

Introduction: Headache disorders have been linked with enhanced atherosclerosis, cortical spreading depression, endovascular dysfunction, vasoconstriction, neurogenic inflammation, hypercoagulability, and cervical artery dissection. We aimed to evaluate the risk of cardiovascular and cerebrovascular disorders amongst patients with status migrainosus and migraine with aura. Methods: We planned a cross-sectional observational study from nationwide inpatient data from 2016-2018. Patients with status migrainosus with intractable migraine, migraine with aura, migraine without aura (simple migraine) were identified and compared with population without no migraine (control) using ICD-10-CM codes. Chi-square test) and mix-effect multivariate survey logistic regression analysis adjusted for vascular events were performed to identify prevalence and risk of association between cerebrovascular and cardiovascular disorders and migraine. Results: We identified 1184130 migraineurs out of which 60140 had status migrainosus with intractable migraine, 45285 had migraine with aura, and 16860 had migraine without aura. Prevalence of identified acute ischemic stroke (AIS) (5.5% vs no-migraine: 1.71%), transient ischemic attack (TIA) (3.99% vs 0.38%), subarachnoid hemorrhage (SAH) (0.13% vs 0.08%), angina (0.07% vs 0.06%) was higher in patients with migraine with aura compared to non-migraineurs. (p&lt;0.0001) In regression analysis, migraine with aura was associated with higher odds of AIS (aOR: 3.7, 95%CI 3.4-4.1) and TIA (11.8, 10.5-13.2). In risk adjusted effect modification analysis, patients with AIS (1.5, 1.2-1.9) and TIA (3.0, 2.1-4.3) had higher odds of severe and extreme disability (APR DRG Severity) in patients with migraine with aura compared to patients with intractable migraine. Conclusion: We found that the patients with migraine with aura had higher risk of stroke than patients with intractable or simple migraine. More prospective studies should be planned to evaluate the effect of long-term management of migraine with aura to mitigate the burden of cerebrovascular events and associated disability. Further studies should be directed towards identifying the relationship between migraine and cardiovascular disorders.

Abstract WP197: The Association Between Atherosclerotic Disease And Cervical Artery Dissection In A Large Population-based Cohort Of Older People

Introduction: While well-established risk factors for cervical artery dissection include trauma and connective tissue disorders, many cases are considered “spontaneous.” Although the incidence of cervical artery dissection is greatest in the young, the prevalence increases with age, suggesting a potential role of vascular disease. In this study, we hypothesized that atherosclerosis may be a risk factor for cervical artery dissection. Methods: We performed a retrospective cohort study using administrative claims data from a 5% sample of Medicare beneficiaries between 2008 and 2018. The exposures of interest were vascular risk factors potentially associated with atherosclerosis including coronary artery disease, hyperlipidemia, hypertension, diabetes mellitus, heart failure, chronic kidney disease, chronic obstructive pulmonary disease, valvular heart disease, atrial fibrillation, tobacco use, and alcohol abuse. The primary outcome was a new diagnosis of cervical artery dissection. Marginal structural Cox models were used to characterize the association between the exposures and outcomes, adjusted for time-dependent confounding, age, sex, race/ethnicity, and prior stroke. Results: Among 2,256,826 eligible Medicare beneficiaries, 1,527 (0.07%) developed cervical artery dissection, with a mean age of 70.8, compared to 71.5 in those without cervical artery dissection. The following exposures were found to be significantly associated with the development of cervical artery dissection: coronary artery disease (1.81 [1.63-2.01]), hyperlipidemia (1.84 [1.61-2.11]), hypertension (2.04 [1.76-2.37]), diabetes mellitus (1.34 [1.21-1.49]), heart failure (1.44 [1.25-1.67]), chronic kidney disease (1.38 [1.20-1.59]), chronic obstructive pulmonary disease (1.3 [1.16-1.46]), valvular heart disease (1.81 [1.60-2.04]), atrial fibrillation (HR 1.75 [95% CI 1.54-1.98]), tobacco use (1.84 [1.57-2.15]), and alcohol abuse (1.84 [1.56-2.16]). Conclusion: In a large population-based cohort of older people, atherosclerotic risk factors were associated with subsequent cervical artery dissection. Further studies exploring the role of atherosclerosis in the development of cervical artery dissection are required.

Abstract WP135: Trends In The Incidence Of Spontaneous Cervical Artery Dissection

Background: Arterial dissection represents a rare but significant cause of ischemic stroke. We hypothesized that the detection rate of arterial dissections has increased in recent decades. Objective: To determine the incidence of cervical artery dissection in a defined population. Methods: We identified Olmsted County, Minnesota residents diagnosed with carotid artery or vertebral artery dissection between 2002 and 2020 using the Rochester Epidemiology Project database. Patients who had suffered major trauma, were under 18 years of age or had intracranial artery dissections were excluded. Virtually all Olmsted County residents receive their medical care within the participating health systems, leading to a high likelihood of complete case ascertainment. We assessed longitudinal trends by dividing the data into 5-year time windows, with the last being a 4-year interval. Incidence rates were adjusted for age and sex. Results: In a 19-year period from 2002 through 2020, 127 patients with a diagnosis of cervical artery dissection were identified. There were 64 females (50.4%) and 63 males (49.6%). The average age at diagnosis was 51.2 years (SD 15.7). There were 63 internal carotid artery dissections (ICAD), 60 vertebral artery dissections (VAD), and three common carotid artery dissections (CCAD) identified. One patient had ICAD and VAD at diagnosis. The overall incidence rate of detection for cervical artery dissection, adjusted for age and sex, was 4.9 per 100,000 person-years (py) (95% CI, 4.0 to 5.7). The incidence rate of ICAD was 2.5 per 100,000 py (95% CI, 1.8 to 3.1). The incidence rate of VAD was 2.3 per 100,000 py (95% CI, 1.7 to 2.9). The incidence rate of CAD gradually increased over time from 2.3 per 100,000 py (95% CI, 1.1 to 3.5) in 2002-2006 to 9.4 per 100,000 py (95% CI, 6.9 to 11.8) in 2017-2020, a 4.2-fold increase. Conclusion: The incidence of detection rate of cervical artery dissection increased over four-fold in the last 19 years. This can potentially be attributed to increased usage of non-invasive angiographic imaging.

Abstract TP165: Missed Diagnosis In Cervical Artery Dissection: A Single Center Cohort Study

Background: Misdiagnosis in Cervical Artery Dissection (CAD) is thought to be uncommon but presenting symptoms and risk factors for misdiagnosis are not well defined. Methods: A nested cohort of patients with acute nontraumatic CAD were identified from a single center (2015-2021). Patients with CAD originally misdiagnosed (visiting a medical provider within 30 days for symptoms related to CAD without diagnosis of CAD) were compared against those diagnosed at presentation using descriptive statistics and unadjusted logistic regression. Results: Of the 52 included patients, 25 (48%) had a stroke at diagnosis, and 14 (27%) were misdiagnosed as non-CAD. Patients misdiagnosed had less severe pre-existing disability (median modified Rankin Scale and interquartile range [IQR], 0 [0-1] vs. 1 [0-1]) and were non-significantly younger (median 45 [35-68] vs. 53 [40-65], p=0.35). There was no difference in the distribution of vascular risk factors between groups. The most common presenting symptoms in misdiagnosed patients, such as focal deficits (43% vs. 42%, p=0.96) and headache (36% vs. 21%, p=0.78) were not associated with misdiagnosis. Less frequent symptoms like Horner’s syndrome (21% vs. 5%, p=0.11), neck pain (21% vs. 8%, p=0.33), and dizziness (14% vs. 5%, p=0.29) were non-significantly more common among patients with misdiagnoses. Conclusions: One-quarter of patients with nontraumatic CAD were misdiagnosed at first presentation. Misdiagnoses may be more common in younger persons with less pre-existing disability, and those with nonspecific symptoms such as dizziness and neck pain. Larger studies are needed to provide more precision in estimates of association.

Abstract WP204: Real World Data On Spontaneous Cervical Artery Dissection From A Comprehensive Stroke Center

Introduction: Cervical artery dissection (CAD) is a common cause of stroke in the young and carries a high risk of early recurrence. We aim to compare the characteristics of patients from a real-world cohort to those from prior randomized controlled trials. Methods: We pooled data from consecutive patients with a diagnosis of spontaneous CAD treated at a comprehensive stroke center who were followed for at least 90 days. We excluded patients with traumatic dissection and those with primary intracranial hemorrhage in the setting of trauma or dissection. We compared the baseline characteristics and stroke recurrence rates in our cohort to the TREAT-CAD (2021) and CADISS (2019) trials. We report recurrence rates in patients treated with single antiplatelet (SAPT), dual antiplatelet (DAPT), and anticoagulation (AC). Results: 80 patients with CAD met our inclusion criteria. Our study sample characteristics differ from TREAT-CAD and CADISS, with our cohort more likely to have hypertension and diabetes but less likely to have a smoking history. The rate of recurrent stroke at 90 days was numerically higher in our patient cohort (6.3%) compared to TREAT-CAD (3.6%) and CADISS (1.6%). The rates of recurrent stroke were 8.6% (3/35) with SAPT, 4.2% (1/24) with DAPT, and 5% (1/20) with AC strategies. Conclusions: Characteristics of a real-world CAD population differ from those enrolled in clinical trials with an overall higher rate of recurrent stroke but comparable rates among patients treated with DAPT and AC. The ongoing STOP-CAD study will compare DAPT to AC with a substantially larger number of patients, with an estimated projection of at least 3000 patients in a multi-center international cohort.

Extracranial Internal Carotid and Vertebral Dissecting Pseudoaneurysms: Clinical Features and Long‐Term Outcomes

Background The formation of dissecting pseudoaneurysms (dPSAs) is a common sequela of cervical artery dissection, which has been suggested to increase thrombotic risk in previous studies. This study reported clinical features and long‐term outcomes of cervical internal carotid (cICA) and vertebral artery (cVA) dPSAs. Methods We performed a retrospective chart review over a 10‐year period (January 2012–December 2021). Baseline demographics and clinical characteristics, medical and endovascular treatments, and long‐term outcomes were reported for cICA and cVA dPSA groups separately. Nonparametric tests were used to compare group differences. Results In our cohort, 120 (12%) of 999 cervical artery dissection patients had dPSA, with 85% occurring in the cICA and 15% in the cVA. Most dPSAs occurred spontaneously or in association with minor trauma. Compared with cICA dPSA, patients with cVA dPSA were younger (median age [range]=34.5 [24–70] versus 52 [30–77]; P &lt;0.01), had a smaller dPSA size (median size [range]=4.5 mm [2–17] versus 8 mm [1.2–32]; P &lt;0.01), and were more likely to reduce in size at follow‐up (median size change [range]=−2.8 mm [−17;0] versus 0 [−24;10.8]). Antithrombotic therapy was predominately aspirin monotherapy. No patients with cVA dPSA experienced recurrent strokes and only 3% of patients with cICA dPSA developed new/recurrent stroke in the territory of dPSA while on an antithrombotic regimen requiring endovascular intervention, and none of the dPSAs ruptured. A total of 98% of the patients had an excellent outcome (modified Rankin scale 0–2 at final follow‐up). Conclusion Most cICA and cVA dPSAs have a benign prognosis with medical therapy alone. Further prospective randomized clinical trials are needed to provide high quality evidence on the necessity of additional endovascular therapy at diagnosis in addition to medical therapy alone.

Comparison of Doppler Ultrasound and Computerized Tomographic Angiography in Evaluation of Cervical Arteries Stenosis in Stroke Patients, a Retrospective Single-Center Study.

There are different diagnostic modalities to investigate atherosclerosis cervical artery disease in suspected stroke patients. We aimed to test the concordance of findings of the two most widely used diagnostic modalities in stroke patients: duplex ultrasound (DUS) and computerized tomographic angiography (CTA). A total of 100 stroke patients were retrospectively included in the study, all of them had DUS followed by CTA. Discrepancies of DUS compared to the CTA results in both the internal carotid and vertebral arteries were found in 44% of the patients. The patients with significant differences in diagnostic results were characterized by older age. Evaluation of the degree of carotid artery stenosis revealed vast differences in patients with 50-69% stenosis found by DUS, in which 45.5% of them had a different percentage of stenosis found by CTA. In studying the degree of stenosis of the vertebral artery, only 47.1% of the patients with more than 50% stenosis found by DUS had the same results with CTA, while the remaining revealed normal or less than 50% stenosis by CTA. The current study emphasizes that CTA is more accurate than DUS in the evaluation of stenosis of the cervical arteries including both the internal carotid and vertebral arteries.

The value of performing cerebrovascular CT angiography in major trauma patients: a 5-year retrospective review

To assess whether routine cerebrovascular imaging is required in all major trauma (MT) patients. All MT patients with cerebrovascular imaging between January 2015 and December 2020 were included in the study. Data were collated regarding the type of indication for computed tomography (CT) angiography imaging, time interval from the initial trauma, relevant trauma diagnoses on initial trauma imaging, and CT angiography. Findings, such as aneurysms, vascular malformations, luminal thrombus, venous sinus thrombosis, or vascular injury, were collated. Subsequent treatment with anti-coagulants/anti-platelets or surgical/radiological intervention was noted. Follow-up imaging was assessed for residual injury or complications. Two hundred and fifty of the 6,251 MT patients underwent dedicated cerebrovascular imaging and were included in the study. Of these 41 (16.4%) had cervical artery or venous sinus injury. Further positive vascular findings were identified in 25/250 patients who presented with an incidental stroke or a vascular abnormality and were mislabelled as MT patients at presentation. One patient with a carotid injury subsequently died following a large infarction. Another patient with vertebral artery injury suffered a non-lethal stroke. No patients underwent surgery or intervention. The present study showed that the overall incidence of detected blunt cerebrovascular injuries was very low (0.6%) and even lower for symptomatic vascular injury (0.03%). Routine cerebrovascular imaging is not recommended in all MT trauma patients, but instead, a continued case-by-case basis should be considered.

Outcomes in acute ischemic stroke patients undergoing endovascular thrombectomy: Cervical internal carotid artery pseudo-occlusion vs. true occlusion.

Pseudo-occlusion of the cervical internal carotid artery (cICA) refers to an absence of intraluminal contrast on computed tomography angiography (CTA), while the artery is patent on digital subtraction angiography during endovascular thrombectomy. We aimed to compare the outcomes between the cICA pseudo-occlusion and true occlusion after thrombectomy. We retrospectively analyzed patients with apparent cICA occlusion on CTA who underwent thrombectomy between January 2016 and August 2021, and divided them into the pseudo-occlusion and true occlusion groups based on angiographic exploration. Recanalization failure was defined as a modified Thrombolysis in Cerebral Infarction score of 0-2a. Poor outcome was defined as a 90-day modified Rankin Scale score of 3-6. Propensity score matching was performed to compare the outcomes. Sensitivity analysis using multivariate-adjusted regression in the original cohort was conducted to test the robustness of the findings. Of the 146 patients included, 79 patients (54.1%) had cICA pseudo-occlusion and 67 patients (45.9%) had true occlusion. Following 1:1 propensity score-matched analysis, patients with pseudo-occlusion had an increased likelihood of recanalization failure (OR, 3.18; 95% CI, 1.06-9.59; P = 0.040) and poor outcome (OR, 2.80; 95% CI, 1.07-7.30; P = 0.035) compared with patients with true occlusion. Sensitivity analysis showed that cICA pseudo-occlusion remained independently associated with recanalization failure (OR, 2.55; 95% CI, 1.07-6.09; P = 0.036) and poor outcome (OR, 2.48; 95% CI, 1.08-5.67; P = 0.032). Patients with cICA pseudo-occlusion on CTA treated with thrombectomy had an increased risk of reperfusion failure and poor outcome compared with true occlusion patients.

The transverse cervical artery cervical cutaneous branch flap: An anatomy-based nomenclature.

The transverse cervical artery cervical cutaneous branch flap: An anatomy-based nomenclature.

The aortic arch of piglets

The morphology of the branches of the aortic arch is an important topic in car- diology. Vessels extending from the aortic arch may differ in number, place of departure in different species of animals, as well as have variations of branching within the same species. However, regardless of the existing variations, all of them are the main arterial highways for organs and tissues of the head, neck and thoracic extremities. Considering the above, we set a goal to study the branches of the aortic arch in piglets and give them a morphometric characteristic. The corpses of newborn piglets of the Landrace breed served as the material for the study. The research method was fine anatomical dissection and morphometry. For fine anatomical dissection, injection of the vascular bed with colored latex was performed. During the study, it was found that two arteries depart from the aortic arch in newborn pig- lets: the left subclavian and the brachiocephalic. When comparing the diameters of these arteries, it can be noted that the distribution of blood flow occurs asymmetrically. The bra- chiocephalic artery has a larger diameter. The brachiocephalic artery follows in the cranial direction and gives off the trunk of the common carotid arteries, after which it continues as the right subclavian artery. The diameter of the trunk of the common carotid arteries ex- ceeds that of the brachiocephalic artery. The diameter of the right subclavian artery did not significantly differ from that of the left subclavian artery. Branches of subclavian arteries include two groups: dorsal and ventral. Mainly the dorsal direction has the costal-cervical trunk, deep cervical and vertebral arteries, and the ventral direction has the brachial trunk, internal thoracic and superficial cervical arteries. The largest artery from the group of dor- sal branches is the costal-cervical trunk. Among the group of ventral branches, two arteries reach the maximum diameter: the internal thoracic and the brachial trunk.

Course and branching of the ascending aorta in a large gray goose (Anser griseo magna)

Large gray goose (Anser griseo magna) – a common agricultural bird, this breed belongs to the meat-sucking group. This breed of geese is distinguished by a strong broad body, the muscles on their chest protrude strongly, the neck is of medium length with a small but very strong head, there is a strongly developed fat fold on the abdomen, the wings are very powerful, dense and massive. The feather of a large gray goose, on the upper part of the body has a gray color and white on the bottom. This breed is famous for its rapid growth and weight gain, when fed only with vegetable feeds, which greatly reduces the cost of feeding. The weight of this bird can reach 7-7.5 kg, literally in 5 months. These characteristics indicate that this bird has highly developed muscle and adipose tissue, for the growth and development of which a stable and proper blood supply is necessary, which is carried out by arterial vessels. Thanks to vascularization, all cells of tissues and organs receive the necessary substances for growth and development. Knowing this fact, we estab- lished the patterns of the course and branching of the ascending aorta in a large gray goose, and determined the morphometric parameters of the main arterial vessels of this collector. It was found that paired brachiocephalic arteries are not symmetrical, their diameter var- ies. The left brachiocephalic artery has a diameter 1.18 times larger than the right one. An interesting fact was that, at the level from the sixth to the third cervical vertebrae, the right and left common carotid arteries merge into one common trunk, and then again diverge into independent arteries. All other vessels have a fairly wide lumen and are well developed. Keywords: goose, large gray goose, aorta, ascending aorta, vascularization.

Treatment of cervical internal carotid artery dissection resulting in intracranial large vessel occlusion treated by mechanical thrombectomy

【目的】急性頭蓋内主幹動脈閉塞に対して，機械的血栓回収療法を施行した頚部内頚動脈解離の解離部位に対する治療選択を，後方視的に検討した．【方法】2015年4月～2022年3月に，当院で機械的血栓回収療法を行った290症例を対象に調査した．診断は臨床症状や画像所見などを総合的に判断し，後方視的に初発症状・神経所見・画像・治療法・転帰を収集した．【結果】頚部内頚動脈解離例は5例で，平均年齢47歳，55歳以下では21%（4/19例）を占め，頭頚部痛発症は2例のみであった．頚部内頚動脈解離に対しては，3例で経皮的血管拡張術を先行させ，うち1例で母血管閉塞，1例で1カ月後に頚部ステント留置術施行，保存加療2例を含め，いずれも治療後に症状の改善を得た．【結語】頚部内頚動脈解離は，若年重症脳卒中の原因疾患として多く，疼痛の訴えがなくても鑑別に挙げる必要があり，個々の症例に応じた治療介入が必要と考えられた．

A Case of Ruptured Middle Cerebral Artery Aneurysm with Cervical Carotid Artery Dissection

A Case of Ruptured Middle Cerebral Artery Aneurysm with Cervical Carotid Artery Dissection

Spontaneous Multiple Cervical Artery Dissections and Recurrent Deep Vein Thrombosis in a Young Adult.

Spontaneous Multiple Cervical Artery Dissections and Recurrent Deep Vein Thrombosis in a Young Adult.

Cervical Artery Dissection: An Important Cause of Stroke in Young

Department of Neurology, AIIMS, New Delhi, India Address for correspondence: Prof. M. V. Padma Srivastava, Department of Neurology, Chief, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India. E-mail: [email protected] Received April 10, 2023 Accepted April 12, 2023