Origin Of Common Carotid Artery Research Articles

Anatomical Variation of the Common Carotid Artery in neck Dissection- Cervical carotid siphon

Knowledge of incidence of morphological variations in the course and branching of the carotid arteries is important for radiological interpretation and surgical correction when they are symptomatic. Internal carotid artery (ICA) is known to show elongation in its extra cranial course. Previous studies have demonstrated the incidence and clinical symptoms of this morphological entity. However, the occurrence of elongation and looping of the common carotid artery (CCA) is seldom reported in the literature. During regular dissections, we came across a rare case of unilateral morphological variation of common carotid artery, in a female cadaver aged about 55 years. CCA presented a pronounced kinking or coiling, 2 cm above the origin of CCA.

A unique case of right cervical aortic arch with anomalous left common carotid artery and absent right common carotid artery.

IntroductionCervical aortic arch is a rare anomaly where-in the ascending aorta arises normally from the left ventricle and extends in such a fashion that the aortic arch is situated high in the neck on either side. This anomaly should be suspected in any child exhibiting a pulsatile swelling in the neck.Case commentaryAn 8 year old child presented with a pulsatile swelling on the right side of the neck since birth. CT angiography revealed right sided cervical aortic arch at C4-C5 level. The left common carotid artery arose from the ascending aorta at D4 with the right external and internal carotid arteries originating separately from the cervical arch. The right and left subclavian arteries arose from the descending aorta at D1 and D4 respectively.DiscussionAlthough most patients with cervical aortic arch are asymptomatic, some have dysphagia from oesophageal compression and respiratory distress from tracheal compression. There are many anatomical variations in cervical aortic arch as mentioned by Haughton. This case is Haughton type A because apart from the presence of right cervical aortic arch, 2 additional oddities in the form of leftward descending aorta and abnormal origin of the left common carotid artery from ascending aorta with absence of right common carotid artery are noted.ConclusionCervical aortic arch is not a very commonly encountered entity and can be quite vexing for those who are seeing such a case in OPD for the first time. Although cervical aortic arch anomalies have been reported in literature, published reports of new cases will help to increase awareness regarding this anomaly and lead to a swift and efficient diagnosis and management.

Transfemoral Stenting of Stenoses at the Common Carotid Artery Origin Using an Anchoring Technique With a Balloon Protection Device

BACKGROUND: Transfemoral stenting of stenoses at the common carotid artery (CCA) origin is technically difficult because of poor stability of the guiding catheter. OBJECTIVE: To describe an anchoring technique using a balloon protection device that provides excellent stability of the guiding catheter. METHODS: Four patients (5 stenotic lesions) with stenosis of the CCA origin underwent transfemoral stenting with a balloon protection device (PercuSurge GuardWire; Medtronic, Santa Rosa, California). These 5 stenotic lesions of the CCA origin included 1 on the right side and 4 on the left side. Two of the stenoses were symptomatic, and 3 were asymptomatic. A balloon-expandable stent (Express LD stent; Boston Scientific, Natick, Massachusetts) was used in all patients. RESULTS: All stenoses were successfully dilated. With the balloon protection device as an anchor in all patients, the guiding catheter was highly stable during the procedure. There were no intraprocedural or periprocedural ischemic complications in any patients. None of the patients developed a stroke during a mean follow-up period of 8.4 months. CONCLUSION: The anchoring technique using a balloon protection device is useful for transfemoral stenting of stenoses at the CCA origin. ABBREVIATIONS: CCA, common carotid artery ECA, external carotid artery ICA, internal carotid artery PTA, percutaneous transluminal angioplasty

Abstract WMP27: Differential Gene Expression in Coiled Versus Flow-diverter Treated Aneurysms: a RNA-Seq Analysis in Rabbit Aneurysm Model

Introduction: Numerous endovascular tools exist for the treatment of intracranial aneurysms with an increased use of flow-diverting devices in recent years. However, the biological mechanisms leading to aneurysm healing or potential complications such as delayed aneurysm ruptures after flow-diverter treatment are not yet well established. We used RNA-sequencing technology to identify genes relevant for biological impact of coils and flow-diverters in elastase-induced saccular aneurysms in rabbits and to identify genes and pathways of potential clinical interest. Methods: Elastase-induced saccular aneurysms were created at the origin of the right common carotid artery. Aneurysms were treated with coils (n=5) or flow-diverters (Pipeline Embolic Device, Covidien, CA) (n=4). Untreated aneurysms (n=6) were used as controls. Messenger RNA and microRNA were isolated from the aneurysms at 4 weeks following treatment. RNA samples were processed using RNA-seq technology. RNA-seq results were analyzed by using the Ingenuity Pathway Analysis tool. Results: Using RNA sequencing for coiled versus non-treated aneurysms, 464 genes were found to be differentially expressed with 58 genes down regulated and 406 genes up regulated. Using the same criteria for the flow-diverter treated aneurysms, 177 genes were found to be differentially expressed with 8 genes down regulated and 169 genes up regulated. Comparing coiled versus flow-diverter treated aneurysms, 13 genes were significantly differentially expressed with 8 down regulated and 5 up regulated genes. Genes identified with the highest interest for aneurysms healing were fibroblast growth factor-23, matrix metalloproteinases (MMP)-1, Scinderin and Basigin (implicated in MMP-2 and MMP-9 regulation). Pathway analysis associated these genes with inflammatory response, cellular migration, and coagulation, among other functions. Conclusions: RNA-sequencing analysis of rabbit aneurysms revealed differential regulation of some key pathways, including inflammation and cellular migration that could explain the different biological mechanisms implicated in aneurysms healing either after coiling or flow-diverter treatments and could explain potential device-related complications.

Anomalous Origin of the Left Common Carotid Artery from the Main Pulmonary Artery: A Rare Association in an Infant with CHARGE Syndrome.

Case Report. Isolated carotid artery originating from the pulmonary trunk is an exceedingly rare anomalous origin of head and neck vessels. We present this finding, along with a persistent embryonic trigeminal artery, in a male infant with multiple cardiac defects and other congenital anomalies associated with CHARGE syndrome. After extensive investigations, cardiac catheterization revealed the anomalous left common carotid artery arising from the cranial aspect of the main pulmonary artery. There was retrograde flow in this vessel, resulting from the lower pulmonary pressure, essentially stealing arterial supply from the left anterior cerebral circulation. The persistent left-sided trigeminal artery provided collateral flow from the posterior circulation to the left internal carotid artery territory, allowing for safe ligation of the anomalous origin of the left common carotid artery, thereby reversing the steal of arterial blood flow into the pulmonary circulation and resulting in a net improvement of cerebral perfusion. Conclusion. The possibility of this vascular anomaly should be considered in all infants with CHARGE syndrome. Surgical repair or ligation should be tailored to the specific patient circumstances, following a careful delineation of all sources of cerebral perfusion.

Stroke as the Sole Manifestation of Takayasu Arteritis in a 15-Year-Old Boy with Latent Tuberculosis.

Introduction. Takayasu arteritis is a rare disease affecting the aorta and its main branches, causing arterial claudication and end-organ ischemia, including stroke. The etiology is unknown but is believed to be autoimmune. An association between Takayasu arteritis and tuberculosis has been suggested, but the possible relation is unclear. Case Presentation. A 15-year-old Somali boy was diagnosed with latent tuberculosis. He had a lesion in the right lung, and both the tuberculin skin test by the Mantoux method and Quantiferon GOLD test turned out positive. After he suffered a cerebral infarct in the right hemisphere, childhood Takayasu arteritis was diagnosed. The diagnosis was based on diagnostic imaging showing a high-grade stenosis of the origin of the right common carotid artery, an occluded common carotid artery on the left side, a circumferential thickening of the vessel walls in the right and left common carotid artery, and laboratory findings with elevated C-reactive protein. Conclusion. Takayasu arteritis is an uncommon cause of stroke. It should however be kept in mind as a cause of cerebrovascular disease, especially in the young.

RNA-Sequencing Analysis of Messenger RNA/MicroRNA in a Rabbit Aneurysm Model Identifies Pathways and Genes of Interest.

Rabbit aneurysm models are used for the testing of embolization devices and elucidating the mechanisms of human intracranial aneurysm growth and healing. We used RNA-sequencing technology to identify genes relevant to induced rabbit aneurysm biology and to identify genes and pathways of potential clinical interest. This process included sequencing microRNAs, which are important regulatory noncoding RNAs. Elastase-induced saccular aneurysms were created at the origin of the right common carotid artery in 6 rabbits. Messenger RNA and microRNA were isolated from the aneurysm and from the control left common carotid artery at 12 weeks and processed by using RNA-sequencing technology. The results from RNA sequencing were analyzed by using the Ingenuity Pathway Analysis tool. A total of 9396 genes were analyzed by using RNA sequencing, 648 (6.9%) of which were found to be significantly differentially expressed between the aneurysms and control tissues (P < .05; false-discovery rate, <0.01; fold change, >2 or <.5). Of these genes, 614 were mapped successfully, 143 were down-regulated, and 471 were up-regulated in the aneurysms as compared with controls. Using the same criteria for significance, 3 microRNAs were identified as down-regulated and 5 were identified as up-regulated. Pathway analysis associated these genes with inflammatory response, cellular migration, and coagulation, among other functions and pathologies. RNA-sequencing analysis of rabbit aneurysms revealed differential regulation of some key pathways, including inflammation and antigen presentation. ANKRD1 and TACR1 were identified as genes of interest in the regulation of matrix metalloproteinases.

Prevalence of Bovine Aortic Arch Configuration in Adult Patients with and without Thoracic Aortic Pathology

Bovine aortic arch (BA) occurs in approximately 15-35% of the US population and is regarded as a clinically insignificant, normal variant. The aim of this study was to assess the prevalence of types I (type I bovine arch [T1BA], common origin of innominate and/or left common carotid artery) and II (type II bovine arch [T2BA], left common carotid originating from innominate) bovine arch in patients with and without thoracic aortic pathology. We retrospectively reviewed all serial computed tomography images (n = 817) performed at our institution over 4 months to determine the overall prevalence of BA. Thoracic aorta and/or arch vessels were visualized, with images read by certified radiologists. A separate analysis compared a series of 156 consecutive patients with thoracic pathology (dissection or aneurysm ≥ 4.0 cm), from a 25-month period, with 757 control patients without pathology from the original sample. Statistical analysis included a chi-squared contingency table. Analysis revealed a bovine arch prevalence of 31.1% (n = 254), including 14.9% T1BA and 16.2% T2BA. Patients with thoracic aortopathy (n = 156) had aortic dissection (n = 26) or aneurysm (n = 130). These patients were older and had an increased prevalence of hypertension, hyperlipidemia, and aortic calcification. In addition, there was increased prevalence of T2BA in the pathology group (23.7%) compared with controls (15.9%; P = 0.03). T1BA was not significantly different between groups (11.5% vs. 14.9%; P = 0.59). When thoracic disease was stratified by pathology type, T2BA occurred more frequently in patients with thoracic aortic aneurysm (24.6% vs. 15.9%; P = 0.04). BA trended upward, in patients with thoracic aortic dissection (42.3% vs. 30.8%; P = 0.28). Our analyses revealed a prevalence of bovine arch of 31% in our patient population. BA occurred more frequently in patients with thoracic aortopathy than controls. Therefore, patients with BA may be associated with higher levels of thoracic aortic pathology and may benefit from increased clinical vigilance.

Aortic arch rescued through double-chimney technique

A 62-year-old man with a history of hypertension, smoking, chronic obstructive pulmonary disease and coronary artery disease had a saccular aneurysm in the distal aortic arch (Figure 1A) involving the origin of the left subclavian artery (LSA), with a maximum diameter of 65 mm and a short proximal neck distancing 13 mm from the origin of the left common carotid artery (LCCA). He was considered at high surgical risk and was referred for thoracic endovascular aortic repair with simultaneous preservation of perfusion of the innominate artery and LCCA through double-chimney technique. The procedure was performed under general anesthesia. A Gore® TAG® stent graft was first inserted through the right common femoral artery and deployed at the distal end of the aneurysm, and a second one was inserted into the ascending aorta distally overlapping with the first. Two Gore® VIABAHN® stent grafts were introduced through the right axillary artery and LCCA and deployed at the proximal edge of the proximal TAG stent graft. Post-procedure computed tomography angiography (CTA) revealed a type II endoleak from the LSA, but follow-up CTA at one month revealed no

Abstract W MP45: RNA-seq Analysis of mRNA/miRNA in Rabbit Aneurysm Model Reveals Similar Expression Patterns to Human Intracranial Aneurysms

Background and Purpose: Rabbit aneurysm models are used in the testing of embolization devices as well as elucidating the mechanisms human intracranial aneurysm growth and healing. We employed ribonucleic acid sequencing (RNA-seq) technology to identify genes relevant to induced rabbit aneurysm biology and compare these with genes related to human intracranial aneurysms to identify genes of potential clinical interest. This included sequencing micro RNA, which are important regulatory non-coding RNA. Materials and Methods: Elastase-induced saccular aneurysms were created at the origin of the right common carotid artery (CCA) in 5 rabbits. Messenger ribonucleic acid (mRNA) and micro ribonucleic acid (miRNA) was isolated from the aneurysm and the control unoperated left CCA at 12 weeks and was processed using RNA-seq technology. The results from RNA-seq were analyzed using Ingenuity Pathway Analysis. Results: 9396 genes were analyzed using RNA-seq, of which 649 (6.9%) were found to be significantly differentially expressed between aneurysm and control tissues (p &lt; 0.05, false discovery rate 2). Of these, 500 were up-regulated in the aneurysm and 149 were down-regulated as compared to controls. Using the same criteria, 3 miRNA were identified as down regulated and 5 were identified as up regulated. Pathway analysis associated these genes with inflammatory response, cellular migration, and coagulation, among other functions and pathologies. Conclusion: RNA-seq next-gen analysis of rabbit aneurysms shows similarities to human intracranial aneurysms with respect to regulation of some key pathways.

Hemodynamic Effects of Proximal Supra-aortic Artery Stenosis on Anterior Cerebral Artery

Alternating flow in the anterior cerebral artery is a rare finding, associated with innominate artery stenosis. We present a series of four patients with this finding on transcranial color coded sonography, under basal conditions. In all of these patients, vascular studies detected an ipsilateral proximal stenosis, three in the innominate artery and, for the first time, one at the left common carotid artery origin. Successful angioplasties with stenting were performed, resulting for the first time in the normalization of orthograde flow in all cases. We conclude that an early systolic hemodynamic compromise in the first segment of the anterior cerebral artery, in the form of alternating flow, is an indirect indicator of ipsilateral proximal stenosis in the supra-aortic arteries, either in the innominate artery or at the origin of the left common carotid artery.

Surgical Management of Free-floating Thrombus within the Common Carotid Artery

Free-floating thrombus (FFT) of the carotid artery is an exceptional medical condition with a currently unclarified pathophysiology. Approximately 150 cases have been described and published in the literature throughout the world so far. Thus, no definite management strategies have been established yet. In this paper, a symptomatic case of an FFT inside the common carotid artery presented with a history of slurred speech, and right sided hemiplegia was reported. After the diagnosis of a mobile thrombus within the origin of the left common carotid artery, the patient was placed on anticoagulation. As the medical therapy failed, carotid thromboendarterectomy was performed.

An unusual origin of the right subclavian artery – arteria lusoria

Abstract The aortic arch usually gives off three major arterial branches: the brachiocephalic trunk, the left common carotid artery and the left subclavian artery. The most frequently occurring developmental variations of arterial trunks origins are a joined brachiocephalic and left common carotid artery origin, the left vertebral artery branching from the aortic arch, a double aortic arch, and a change of sequence of branching arteries. The current report presents the rare asymptomatic situation of the right subclavian artery originating as the last individual branching from the aortic arch. This abnormality was accidentally discovered in a computed tomography examination of a 69-year old male patient. The examination showed that the artery went towards the neck posteriorly from the trachea. The anatomical anomaly was interpreted as being an arteria lusoria.

Open Reconstructions for Symptomatic Atherosclerotic Lesions of the Supra-aortic Vessels: Thirty Years Results from Two University Hospitals

Atherosclerotic lesions at the origin of common carotid, subclavian, and innominate arteries are causes for brain and hand ischemic symptoms. Surgical reconstructions of symptomatic cases remain the golden standard treatment, although the endovascular approach has been promising as well. In this retrospective study, long-term results of open reconstructions from 2 University Hospitals are presented. Through a 30-year period, prospective data of 107 patients, suffering from symptomatic atherosclerotic supra-aortic artery disease, were retrospectively reviewed and included in this study. Demographic data, arterial risk factors, presenting symptoms and signs, diagnostic evaluation, operative treatment and complications, resolution of symptoms, redo surgery, and overall mortality were analyzed. Eighty-one patients were operated on for subclavian, 14 for innominate, and 12 for common carotid severe lesions, through an extra-thoracic reconstruction (91 patients) or a transthoracic one (16 patients). Perioperative mortality was null although morbidity was 16.8%, and primary perioperative patency was 97.2% (secondary patency 100%). The cumulative primary patency was 95.3%, 90.7%, and 86.0% at 5, 10, and 15 years, respectively. The mean time of patency was 214.6 months (95% confidence interval = 198.5-230.6), with no difference between transthoracic and extrathoracic reconstructions (P = 0.278). Open reconstructions remain a therapeutic strategy with a considerably low perioperative morbidity/mortality offering excellent long-term results regarding patency of the reconstructions and clinical resolution of the symptoms. However, in the modern era of the endovascular techniques, we need more studies for establishing anatomic and clinical criteria regarding patient selection for endovascular angioplasty/stenting or open repair.

Retroesophageal Right Subclavian Artery

During routine dissection of head and neck region in a 65-year-old female cadaver variation in the origin of right subclavian artery was found. The right subclavian artery originated as a direct branch of arch of aorta distal to the origin of left subclavian artery and it was found passing behind esophagus (retroesophageal) and ascending upwards to the right side while the left subclavian artery originated normally from arch of aorta distal to the origin of left common carotid artery. Anomalous variations in the origin and course of arteries have serious implications in angiographic and surgical procedures; hence it is of great importance to be aware of such possibilities of variations.

Right Cerebral Hemispheric Hypoperfusion Caused by Type A Aortic Dissection and Intramural Hematoma

Background: Acute aortic dissection typically manifests severe abrupt chest or back pain which can be accompanied by various neurologic symptoms. However, in case without typical pain, the accurate diagnosis is very difficult. Case Report: A 77-year old female patient presented with symptoms of right cerebral hypoperfusion such as altered mental status, left sided hemiplegia and hypesthesia, tonic-clonic movement and right sided gaze deviation. Initial brain CT angiography revealed a dissection of ascending aorta and intramural hematoma compressing the origin of common carotid artery. Perfusion brain CT showed the prolonged time to peak and mean transit time for right cerebral hemisphere. Emergent replacement of ascending aorta and hemiarch was done without complication. Conclusion: Cerebral hemispheric hypoperfusion could be initial manifestations of the aortic dissection. Aortic dissection should be discriminated in a patient with neurologic deficit accompanied by atypical systemic symptoms. J Neurocrit Care 2014;7(1):44-47

Right Cerebral Hemispheric Hypoperfusion Caused by Type A Aortic Dissection and Intramural Hematoma

Background: Acute aortic dissection typically manifests severe abrupt chest or back pain which can be accompanied by various neurologic symptoms. However, in case without typical pain, the accurate diagnosis is very difficult. Case Report: A 77-year old female patient presented with symptoms of right cerebral hypoperfusion such as altered mental status, left sided hemiplegia and hypesthesia, tonic-clonic movement and right sided gaze deviation. Initial brain CT angiography revealed a dissection of ascending aorta and intramural hematoma compressing the origin of common carotid artery. Perfusion brain CT showed the prolonged time to peak and mean transit time for right cerebral hemisphere. Emergent replacement of ascending aorta and hemiarch was done without complication. Conclusion: Cerebral hemispheric hypoperfusion could be initial manifestations of the aortic dissection. Aortic dissection should be discriminated in a patient with neurologic deficit accompanied by atypical systemic symptoms. Key Words: Aortic disease; Dissection; Neurologic manifestations

Blunt Partial Transection of the Innominate Artery

Introduction Innominate artery injury occurs, although rare. The innominate artery is the second most common aortic vessel injured as a result of blunt trauma. A blunt mechanism has been associated with up to 35% of innominate artery injuries. Associated innominate artery injuries include aortic or aortic branch injury, pneumothorax, rib fracture, head trauma, and long bone extremity fracture. Traditionally, surgical correction has been the preferred management option. Surgical options include the use of a graft verses primary repair, a bypass exclusion technique, cardiopulmonary bypass, and profound hypothermia or shunts, especially to maintain or protect cerebral perfusion. Stenting is another treatment option. The use and timing of these interventions depends on the characteristics of the innominate artery injury, associated concomitant injuries, resources of the facility, and comfort level of the surgeon. The branching pattern of the human aortic arch is varied. These variations should be kept in mind when dealing with great vessel injuries. The term “bovine arch” will not be used to describe the aortic arch branching pattern anomaly found in the current case as a true bovine arch involves a large brachiocephalic trunk that gives rise to both subclavian arteries and a bicarotid trunk. Two forms of human anomalous arch anatomy have been described as a bovine arch. The first arch variant is characterized as having a common origin of the innominate artery and the left common carotid artery. In a report by Layton and colleagues, they indicated that this variant occurred in approximately 13% of patients. He also reported that the second variant, in which the origin of the left common carotid artery arises from the innominate artery, occurs in less than 10% of the general population. The presence of these anomalies may contribute to the location of a great vessel injury as well as influence the management of the resulting injury in regards to maintaining cerebral perfusion. We report the case of an innominate artery injury in a man with anomalous arch circulation and our management of the injury.

Ascending aorta and aortic arch pseudoanaeurysm — case report

Cardiologia CROATICA We present a 53-year-old patient who was admitted with high fever, cough and nasal discharge. She received her kidney transplant ten years ago with subsequent taking of common immunosupressive therapy with several past hospitalizations due to respiratory infections and respiratory failure. Twenty years ago, she underwent an urgent neurosurgical procedure due to subarachnoid bleeding with underlying ruptured intracranial anaeurysm. One month before actual hospitalization, the patient was complaining of chest pain. Diagnostic work-up of the infection included native computerised tomography (CT) of the thorax and abdomen with coincidental finding of the ascending aorta and aortic arch anaeurysm. Subsequent CT aortography with reconstructions was performed showing pseudoanaeurysm of the ascending aorta and aortic arch (6.2x2.7cm) anteriorly and laterally of the ascending aorta and arch until the origin of the left common carotid and left subclavian artery with wide communication of the aorta and pseudoanaeurysm. Anaeurysmatic dilatation of the splenic artery was diagnosed as well (2.6 cm). Cardiothoracic operation was planned and coronary angiography (transfemoral) was performed as well with the normal finding of the epicardial coronary arteries but with postprocedural haemorrhagic complication with large ipsilateral haematoma of the rectus abdominis and retroperitoneum requiring percutaneous occlusion with BeadBlock Terumo spheric particles of the inferior epigastric artery with an optimal result. Several heamodialysis procedures were undertaken after all contrast imaging procedures in order to protect the transplanted renal graft. Due to a blood loss, the patient was transfused with seven units of blood altogether. She was treated with meropenem and is afebrile with good general condition pending operation of the aorta.

Pulsating Suprasternal Lump: a Diagnostic and Management Dilemma

We report a 70-year-old female who complained of shortness of breath and a pulsating suprasternal lump. CT scan showed innominate artery dilatation. In addition, operative exposure showed tortuous arteries and a common origin of the left common carotid and innominate arteries. Surgical correction by innominate artery division and reimplantation at the ascending aorta was performed, and the patient's symptoms completely disappeared after the procedure.