Compression Of Carotid Artery Research Articles

Ischemic stroke due to stylocarotid artery syndrome: a case report and review.

Stylocarotid artery syndrome (SAS) is a rare variant of Eagle's syndrome that may lead to transient ischemic attack or stroke. The underlying pathophysiological mechanism involves compression of the internal carotid artery by an elongated styloid process (ESP), potentially resulting in vascular occlusion or dissection. An ESP exceeding 2.5 cm is deemed elongated, with a length of 3.0 cm considered clinically significant. Although the prevalence of ESP ranges from 4.0% to 7.3%, symptomatic cases are rare; symptoms are present in only approximately 4.0% of individuals with an ESP. Unlike the typical symptoms of Eagle's syndrome, SAS may not cause pharyngeal discomfort, the sensation of a foreign body in the throat, dysphagia, or facial pain. This absence of characteristic symptoms as well as the development of central nervous system symptoms often leads patients to seek care from neurologists instead of otolaryngologists, increasing the likelihood of misdiagnosis or underdiagnosis. We herein report a unique case of ischemic stroke caused by SAS and present a literature review on cases of SAS-associated ischemic stroke published in the past decade. The reporting of this study conforms to the CARE guidelines.

Thromboembolism From Hyoid Bone-Related Direct Carotid Artery Compression.

Thromboembolism From Hyoid Bone-Related Direct Carotid Artery Compression.

Management of Carotid Cavernous Fistula: a Case Report of Carotid Cavernous Fistula (CCF)

Abstract
 Introduction : Carotid-cavernous fistula (CCF) is an abnormal connection between the carotid arterial system and the sinus cavernous. Abnormal vascular shunt allowed blood to flow either direct or indirect from the carotid artery into the sinus cavernous. The indications for treatment of CCF are increased ocular pressure, double vision, bruits, severe headache, and severe proptosis resulting in keratopathy due to exposed cornea. Management of CCF include conservative management, endovascular intervention, surgery, and radiology intervention.
 Case Illustration : A 61 years old female came to the hospital complained redness on both eyes since 6 months ago, the redness in these eyes unrelieved even they had been treated. The patient have history given three types of drugs but there was not improvement. physical examination shown proptosis, injection of episcleral, cloudy lens with LOCSS NC2NO2C1P1 on both eyes, other examination also shown bruit on both eyes, Laboratory results was in normal limit. Funduscopic examination shown tigroid appearance.
 Discussion : Arterialization of the conjunctival vessels is a characteristic feature of CCF, other than physical examination, patient was planned for CT angiography examination to find external causes of injury assessing ICH and ischemia. Patient got external manual compression of the ipsilateral cervical carotid artery for about 30 to 40 seconds four times per hour several times daily for 4-6 weeks.
 Conclusion : Although CCF initially can be mistaken for conjunctivitis or episcleritis. Methods of therapy for CCF include conservative management, endovascular intervention, surgery, and interventional radiology. CCF itself is generally not life threatening but requires treatment to prevent worsening of the eye

Abstract 018: External carotid artery Pseudo aneurysm induced Internal Carotid Artery compression causing acute ischemic stroke

Introduction Here, we describe a patient in whom ischemic stroke was caused by compression of the Internal Carotid Artery (ICA) by a Pseudoaneurysm (PSA) of the External Carotid Artery (ECA) after Gun Shot injury. Eventually, the PSA of the Internal maxillary artery (IMAX) was embolized, resulting in resolution of the patient's symptoms. Methods Case Report Results A 75‐year‐old male with a history of atrial fibrillation on Eliquis presented to the emergency department after sustaining a gunshot wound to the left face. He had extensive injuries through the left masticator and submandibular space with an inferior orbital wall fracture. A Computed Tomography Angiography (CTA) neck showed injuries to the left proximal IMAX with a small PSA. As the PSA was asymptomatic it was managed with observation. On HOD day 13, CTA was done for a brief period of unresponsiveness, which showed high‐grade narrowing of left cervical ICA due to extrinsic compression from PSA which was supplied by a branch of the left ECA with distal re‐constitution (image A). The next day, patient developed right sided plegia and aphasia with NIHSS of 17. A CT head showed no acute intracranial abnormality. The patient underwent emergent Digital Subtraction Angiography (DSA), which demonstrated occlusion of the left cervical ICA from compression from a left IMAX PSA which was treated with n‐butyl‐cyanoacrylate TRUFILL embolization with resolution of flow limitation in the left cervical ICA (Image B1,B2). After embolization, the patient was oriented and able to lift right arm and leg anti‐gravity. Magnetic Resonance Imaging (MRI) was contraindicated due to retained bullet fragments. Repeat CT head did not show stroke. Conclusion A Pseudo aneurysm is characterized by a rupture of the arterial wall and the formation of an aneurysmal sac by the adjacent structures while the sustaining artery remains intact. The most prevalent causes are penetrating or acute blunt neck trauma, hyperextension injury, and injury to the base of the skull (1). Predisposing factors for PSA include carotid endarterectomy or a late complication of carotid artery dissection, infection, radiotherapy, and malignancy (1‐2). Cox et al. reported 124 patients with significant neck and head penetrating injuries. Eleven patients were found to have thirteen head and neck PSA: two in the ICA, one in the vertebral artery, and ten involving branches of the ECA. Two of seven symptomatic PSAs manifested with episodes of massive hemorrhage (3). There have been case reports describing the consequences of an elongated styloid process causing an ischemic stroke due to subsequent dissection and PSA formation (4). According to our knowledge, this case report is one of the first to describe acute ischemic symptoms resulting from ECA PSA‐induced ICA compression, with resolution of symptoms following PSA embolization. The educational value of our case lies not only in the rarity of the condition but also in the uniqueness of its presentation. This case is a fundamental addition to the existing literature on rare neuro‐vascular anomalies leading to potential catastrophic outcomes.

Impaired cerebrovascular reactivity correlates with reduced retinal vessel density in patients with carotid artery stenosis: Cross-sectional, single center study.

The cerebral and retinal circulation systems are developmentally, anatomically, and physiologically interconnected. Thus, we hypothesized that hypoperfusion due to atherosclerotic stenosis of the internal carotid artery (ICA) can result in disturbances of both cerebral and retinal microcirculations. We aimed to characterize parameters indicating cerebrovascular reactivity (CVR) and retinal microvascular density in patients with ICA stenosis, and assess if there is correlation between them. In this cross-sectional study the middle cerebral artery (MCA) blood flow velocity was measured by transcranial Doppler (TCD) and, simultaneously, continuous non-invasive arterial blood pressure measurement was performed on the radial artery by applanation tonometry. CVR was assessed based on the response to the common carotid artery compression (CCC) test. The transient hyperemic response ratio (THRR) and cerebral arterial resistance transient hyperemic response ratio (CAR-THRR) were calculated. Optical coherence tomography angiography (OCTA) was used to determine vessel density (VD) on the papilla whole image for all (VDP-WIall) and for small vessels (VDP-WIsmall). The same was done in the peripapillary region: all (VDPPall), and small (VDPPsmall) vessels. The VD of superficial (VDMspf) and deep (VDMdeep) macula was also determined. Significance was accepted when p<0.05. Twenty-four ICA stenotic patients were evaluated. Both CVR and retinal VD were characterized. There was a significant, negative correlation between CAR-THRR (median = -0.40) and VDPPsmall vessels (median = 52%), as well as between VDPPall vessels (median = 58%), and similar correlation between CAR-THRR and VDP-WIsmall (median = 49.5%) and between VDP-WIall (median = 55%). The significant correlation between impaired cerebrovascular reactivity and retinal vessel density in patients with ICA stenosis suggests a common mechanism of action. We propose that the combined use of these diagnostic tools (TCD and OCTA) helps to better identify patients with increased ischemic or other cerebrovascular risks.

Assessment of cerebral autoregulatory function and inter-hemispheric blood flow in older adults with internal carotid artery stenosis using transcranial Doppler sonography-based measurement of transient hyperemic response after carotid artery compression

Unhealthy vascular aging promotes atherogenesis, which may lead to significant internal carotid artery stenosis (CAS) in 5 to 7.5% of older adults. The pathogenic factors that promote accelerated vascular aging and CAS also affect the downstream portion of the cerebral microcirculation in these patients. Primary treatments of significant CAS are eversion endarterectomy or endarterectomy with patch plasty. Factors that determine adequate hemodynamic compensation and thereby the clinical consequences of CAS as well as medical and surgical complications of carotid reconstruction surgery likely involve the anatomy of the circle of Willis (CoW), the magnitude of compensatory inter-hemispheric blood flow, and the effectiveness of cerebral microcirculatory blood flow autoregulation. This study aimed to test two hypotheses based on this theory. First, we hypothesized that patients with symptomatic and asymptomatic CAS would exhibit differences in autoregulatory function and inter-hemispheric blood flow. Second, we predicted that anatomically compromised CoW would associate with impaired inter-hemispheric blood flow compensation. We enrolled older adults with symptomatic or asymptomatic internal CAS (>70% NASCET criteria; n = 46) and assessed CoW integrity by CT angiography. We evaluated transient hyperemic responses in the middle cerebral arteries (MCA) after common carotid artery compression (CCC; 10 s) by transcranial Doppler sonography (TCD). We compared parameters reflecting autoregulatory function (e.g., transient hyperemic response ratio [THRR], return to baseline time [RTB], changes of vascular resistance) and inter-hemispheric blood flow (residual blood flow velocity). Our findings revealed that CAS was associated with impaired cerebral vascular reactivity. However, we did not observe significant differences in autoregulatory function or inter-hemispheric blood flow between patients with symptomatic and asymptomatic CAS. Moreover, anatomically compromised CoW did not significantly affect these parameters. Notably, we observed an inverse correlation between RTB and THRR, and 49% of CAS patients exhibited a delayed THRR, which associated with decreased inter-hemispheric blood flow. Future studies should investigate how TCD-based evaluation of autoregulatory function and inter-hemispheric blood flow can be used to optimize surgical techniques and patient selection for internal carotid artery revascularization.

Eagle Syndrome with Internal Carotid Artery Compression causing Recurred Syncope: A Case Report.

We herein report a 54-year-old man with eagle syndrome who presented with repeated episodes of syncope, especially after moving his head to a downward position. Computed tomography with contrast revealed a bilateral elongated styloid process. The left internal carotid artery was obviously compressed by the left elongated styloid processes. A transcranial Doppler examination detected a significantly decreased blood flow velocity in the left middle cerebral artery when the patient slightly lowered his head position. After surgery, the positional cerebral blood flow alteration disappeared. No further similar syncope episodes have been reported to date.

Point-of-care ultrasound compression of the carotid artery for pulse determination in cardiopulmonary resuscitation

AimTo identify whether a novel pulse check technique, carotid artery compression using an ultrasound probe, can reduce pulse check times compared to manual palpation (MP). MethodsThis prospective study was conducted in an emergency department between February and December 2021. A physician applied point-of-care ultrasound–carotid artery compression (POCUS-CAC) and assessed the carotid artery compressibility and pulsatility by probe compression during rhythm check time. Another clinician performed MP of the femoral artery. The primary outcome was the difference in the average time for pulse assessment between POCUS-CAC and MP. The secondary outcomes included the time difference in each pulse check between methods, the proportion of times greater than 5 s and 10 s, and the prediction of return of spontaneous circulation (ROSC) during ongoing chest compression. Results25 cardiac arrest patients and 155 pulse checks were analyzed. The median (interquartile range) average time to carotid pulse identification per patient using POCUS-CAC was 1.62 (1.14–2.14) s compared to 3.50 (2.99–4.99) s with MP. In all 155 pulse checks, the POCUS-CAC time to determine ROSC was significantly shortened to 0.44 times the MP time (P < 0.001). The POCUS-CAC approach never exceeded 10 s, and the number of patients who required more than 5 s was significantly lower (5 vs. 37, P < 0.001). Under continuous chest compression, six pulse checks predicted the ROSC. ConclusionsWe found that emergency physicians could quickly determine pulses by applying simple POCUS compression of the carotid artery in cardiac arrest patients.

Exophytic and Fungating Papillary Thyroid Carcinoma: A Rare and Complex Presentation of a Well-differentiated Malignancy

Papillary thyroid carcinoma is the most common well-differentiated thyroid malignancy accounting for more than 80 to 90% of all thyroid tumors. It has an overall excellent prognosis owing to advances in screening via imaging and ultrasound-guided fine-needle aspiration biopsy, which have facilitated early detection, diagnosis, and surgical treatment followed by adjuvant radioactive iodine therapy. Exceptionally rare cases of papillary thyroid tumors may present with enormous growth due to delayed consultation and, thus, late diagnosis, posing a challenge to definitive management, quality of life, overall survival, and prognosis. We report a case of a 35-year-old woman who presented with a 4-year history of a bleeding exophytic and fungating anterior neck mass. Computed tomography showed a fungating mass arising from the left thyroid lobe that measured 14.1 x 14.0 x 11.1 cm with areas of necrosis and hemorrhage, left internal jugular vein thrombus formation, and compression of the left internal carotid artery. The mass causes a displacement of the trachea to the right side and multiple bilateral cervical lymphadenopathies. The patient was fully aware, and she consented to undergo wide excision, total thyroidectomy, neck dissection, and pectoralis major muscle flap reconstruction. However, she went into arrest intraoperatively attributed to massive pulmonary embolism. Papillary thyroid cancer is well known for its excellent prognosis. However, outcomes may not be favorable and can even be fatal in advanced and extensive cases. Although fungating papillary cancers are rare, they remain more common in the developing countries, where early detection and access to healthcare remains limited. They also represent a big challenge to surgeons. Even if the outcome was not good, we opted to report this case as there were many learning points. If only patients with good and excellent outcomes are reported in the literature, it will overestimate the treatment success of these complex cases.

Pseudostroke as a manifestation of mediastinal choriocarcinoma in an elderly man

We describe a rare clinical case: onset of acute neurological symptoms suggestive of a pesudostroke, caused by an imbalance in cerebral blood flow as a result of internal carotid artery compression by an enlarged lymph node secondary to metastases from a disseminated non-gestational mediastinal choriocarcinoma. This was accompanied by decompensation due to paraneoplastic coagulopathy.

Cervicothoracic lipoblastoma: three case reports and review of literature

BackgroundLipoblastoma is a rare benign mesenchymal tumor of embryonal fat affecting mainly children below 3 years of age. It presents usually as a painless rapidly growing soft lobular mass in the extremities, trunk, and less frequently in the head-neck region. Preoperative imaging is used to assess the extent of disease and aid surgical planning. Complete surgical excision without injury to surrounding vital structures is the treatment of choice.Case presentationWe report three interesting lipoblastoma cases: mediastinal lipoblastoma with airway compression and ipsilateral diaphragmatic eventration, neck lipoblastoma with intrathoracic extension, and huge thoracic inlet lipoblastoma with compression of common carotid and Lt subclavian arteries, brachial plexus, and ipsilateral diaphragmatic eventration. Complete excision of lipoblastoma mass was done via neck incision in two cases, and the third case required thoracoscopic excision of intrathoracic remnant 6 months later. All three patients had an excellent outcome.ConclusionsManagement of cervicothoracic lipoblastoma is a surgical challenge due to the potential for rapid growth and extension to different fascial planes; however, successful excision can be achieved via a neck approach. Complete surgical excision is essential to prevent local recurrence and improve the outcome.

Multicenter study: outcomes of carotid endarterectomy depending on configuration of circle of Willis

BACKGROUND: The circle of Willis (CW) is an important network of collaterals that provide compensatory redistribution of hemodynamic load. Several studies showed that the CW is open in approximately 50%90% of cases, and the number of missing segments correlates with low brain tolerance to ischemia in internal carotid artery (ICA) compression. Currently, studies dedicated to the relationship of different configurations of CW with the risk of ischemic brain damage.&#x0D; AIM: The analyze the immediate results of eversion carotid endarterectomy (CEA) in patients with different configurations of the structure of the CW.&#x0D; MATERIALS AND METHODS: We included 641 patients with hemodynamically significant stenosis of the internal carotid arteries (ICA) in a study period from 2010 to 2020. All patients underwent multispiral computed tomography with angiography of the extracranial and CW arteries. Based on the structural variants of the CW, six groups of patients were studied: group 1 (64.9%, n = 416) closed posterior part (CPP) with the existence of posterior communicative artery (PCA) and P1 segment of the posterior cerebral artery (PCerA); group 2 (27%, n = 173) an intermediate structure of the posterior part (IPP) with hypoplasia of the PCA or PCerA; group 3 (8.1%, n = 52) open posterior part (OPP) with the absence of PCA or PCerA; group 4 (85.95%, n = 551) closed anterior part (CAP) with the presence of the anterior communicating artery (ACA) and A1 segment of the anterior cerebral artery (ACerA); group 5 (7.95%, n = 51) an intermediate structure of the anterior part (IAP) with hypoplasia of ACA or ACerA; group 6 (6.1%, n = 39) open anterior part (OAP) with the absence of ACA or ACerA. To assess the compensatory potentials of the brain, all patients underwent measurement of the retrograde pressure in the ICA and intraoperative cerebral oximetry.&#x0D; RESULTS: In the postoperative period, 1 death was recorded in group 4 (CAP) due to a hemorrhagic transformation in the zone of ischemic stroke, on the background development of hyperperfusion syndrome. The largest number of ischemic strokes of the cardioembolic subtype was diagnosed in the ACerA territory in the presence of an unstable atherosclerotic plaque: group 1 (CPP) 0%; group 2 (IPP) 0%; group 3 (OPP) 0.24%, n = 1; group 4 (CAP) 0.18%, n = 1; group 5 (IAP) 1.96%, n = 1; group 6 (OAP) 5.1%, n = 2; p 0.9999. The probable cause was embolization against the background increase in the arterial pressure before ICA clamping. In turn, the majority of ischemic strokes of the hemodynamic subtype developed in the territory of PCerA: group 1 (CPP) 0%; group 2 (IPP) 1.73%, n = 3; group 3 (OPP) 3.8%, n = 2; group 4 (CAP) 0.18%, n = 1; group 5 (IAP) 0%; group 6 (OAP) 2.56%, n = 1; p 0.9999. This pattern coincided with the largest number of patients with CW of the IPP and OPP types among all open variants of the structure.&#x0D; CONCLUSION: Parameters of retrograde pressure in the ICA and intraoperative cerebral oximetry do not always demonstrate the need for a temporary shunt (TS). Due to the opened structure of CW, the redistribution of blood flow occurs with the formation of zones of hypo- and hyperperfusion, causing ischemic alterations in the brain matter. Thus, in order to maintain adequate cerebral hemodynamics, to mitigate the effect of hypo- and hyperperfusion, and reduce the risk of ischemic stroke, the open variant of the CW structure should be considered as an indication for a TS.

Cerebral Infarction from Compression of the Internal Carotid Artery - A Rare Presentation of Pituitary Apoplexy

A 42-year-old female presented with sudden onset of headaches, left hemiplegia and bitemporal hemianopia. Radiological investigations revealed right anterior circulation infarction from mechanical obstruction of the right internal carotid artery by Pituitary Apoplexy. She underwent an urgent transsphenoidal decompression of the sella and had gradual resolution of symptoms.

Failed endovascular therapy for acute internal carotid artery occlusion from pituitary apoplexy: illustrative case

BACKGROUNDLarge pituitary adenomas can rarely cause compression of the cavernous internal carotid artery (ICA) due to chronic tumor compression or invasion. Here, the authors present a case of pituitary apoplexy causing acute bilateral ICA occlusion with resultant stroke. Our middle-aged patient presented with sudden vision loss and experienced rapid deterioration requiring intubation. Computed tomography (CT) angiography revealed a large pituitary mass causing severe stenosis of the bilateral ICAs. CT perfusion revealed a significant perfusion delay in the anterior circulation. The patient was taken for cerebral angiography, and balloon angioplasty was attempted with no improvement in arterial flow. Resection of the tumor was then performed, with successful restoration of blood flow. Despite restoration of luminal patency, the patient experienced bilateral ICA infarcts.OBSERVATIONSPituitary apoplexy can present as an acute stroke due to flow-limiting carotid compression. Balloon angioplasty is ineffective for the treatment of this type of compression. Surgical removal of the tumor restores the flow and luminal caliber of the ICA.LESSONSPituitary apoplexy can be a rare presentation of acute stroke and should be managed with immediate surgical decompression rather than attempted angioplasty in order to restore blood flow and prevent the development of cerebral ischemia.

Editors' Note: Teaching NeuroImages: Pseudopathologic Brain Parenchymal Enhancement due to Vascular Compression in Parotid Tumor

In “Teaching NeuroImages: Pseudopathologic Brain Parenchymal Enhancement due to Vascular Compression in Parotid Tumor,” Teixeira et al. present a CT angiogram (CTA) obtained through right antecubital vein injection that shows intracranial vascular reflux in the cortical veins and pseudopathologic enhancement of the right brain parenchyma in a patient with a right-sided parotid gland tumor who had transient left hemiparesis but had a normal digital subtraction angiogram (DSA) and a normal repeat CTA obtained through left-sided vein injection. The authors initially described the enhancement as being in the distribution of the right middle cerebral artery territory, but they subsequently agreed with Chen et al. that the involvement of the occipital lobe suggests the enhancement pattern is more consistent with the drainage territory of the right superficial cerebral veins. Chen et al. note the mechanism for this finding is unclear and question (1) whether the DSA showed any anomalies in the venous sinuses; and (2) whether the pseudopathologic enhancement could have been related to the fact that the initial injection was performed through a right-sided vein, suggesting there could be severe stenosis of the right brachiocephalic vein. On further review, Teixeira et al. reported the DSA showed a hypoplastic right anterior cerebral artery, occlusion of the right internal jugular vein, and critical stenosis of the right vertebral artery origin. They suspect the patient's symptoms were the result of compression of the right internal carotid artery by the tumor in the setting of right vertebral artery stenosis, which led directly to either compensatory vasodilation or precipitated blood-brain barrier disruption. Although there was also occlusion of the right internal jugular vein, the patent right external jugular vein may have led to rapid spread of contrast into the right hemisphere and retrograde flow into the dilated capillary bed. They postulated that the CTA obtained through left-sided injection was normal because either the patent left internal jugular vein reduced the contrast velocity or vascular autoregulation was reestablished. In “Teaching NeuroImages: Pseudopathologic Brain Parenchymal Enhancement due to Vascular Compression in Parotid Tumor,” Teixeira et al. present a CT angiogram (CTA) obtained through right antecubital vein injection that shows intracranial vascular reflux in the cortical veins and pseudopathologic enhancement of the right brain parenchyma in a patient with a right-sided parotid gland tumor who had transient left hemiparesis but had a normal digital subtraction angiogram (DSA) and a normal repeat CTA obtained through left-sided vein injection. The authors initially described the enhancement as being in the distribution of the right middle cerebral artery territory, but they subsequently agreed with Chen et al. that the involvement of the occipital lobe suggests the enhancement pattern is more consistent with the drainage territory of the right superficial cerebral veins. Chen et al. note the mechanism for this finding is unclear and question (1) whether the DSA showed any anomalies in the venous sinuses; and (2) whether the pseudopathologic enhancement could have been related to the fact that the initial injection was performed through a right-sided vein, suggesting there could be severe stenosis of the right brachiocephalic vein. On further review, Teixeira et al. reported the DSA showed a hypoplastic right anterior cerebral artery, occlusion of the right internal jugular vein, and critical stenosis of the right vertebral artery origin. They suspect the patient's symptoms were the result of compression of the right internal carotid artery by the tumor in the setting of right vertebral artery stenosis, which led directly to either compensatory vasodilation or precipitated blood-brain barrier disruption. Although there was also occlusion of the right internal jugular vein, the patent right external jugular vein may have led to rapid spread of contrast into the right hemisphere and retrograde flow into the dilated capillary bed. They postulated that the CTA obtained through left-sided injection was normal because either the patent left internal jugular vein reduced the contrast velocity or vascular autoregulation was reestablished.

Abstract #1000835: Ischemic Stroke as a Rare Complication of Multinodular Goiter

Enlargement of a multinodular goiter is a common finding which can result in compression of structures in the vicinity. A rare example is arterial compression by a large substernal goiter that can compromise cerebral blood flow. We present a unique case of an enlarged thyroid, which caused substantial compression of the left common carotid artery leading to ischemic stroke.

Recurrent Head and Neck Adenocarcinoma Presenting With a Pituitary Mass

Abstract Background: Metastasis to the pituitary gland is a rare condition. Only 1.8% of all surgically resected pituitary masses are metastases with the majority originating in the breast and lung (1). Salivary gland tumors rarely metastasize to the brain and only a few cases have been reported in the literature. Clinical Case: A 61 year-old woman presented to an outside emergency department with horizontal diplopia, blurry vision and left-sided sharp frontal headaches. MRI of the head showed a large, 2.0 x 4.6 x 1.8 cm sellar/suprasellar mass involving both cavernous sinuses, encasing the right internal carotid artery which was narrowed, and compressing the optic chiasm. Her past medical history was significant for adenocarcinoma of the left buccal mucosa and masseteric space, treated with resection in 2016, and a second resection in 2018 for recurrence followed by radiation therapy. Areas were identified where focal perineural invasion was present. She was referred to our institution for treatment recommendations for the sellar/suprasellar lesion. Laboratory testing revealed secondary hypothyroidism, adrenal insufficiency and partial diabetes insipidus, and she was started on replacement hormone therapy with levothyroxine and hydrocortisone. Neurosurgery and ENT evaluated patient and a surgical biopsy and subtotal resection via an endoscopic endonasal transsphenoidal approach was recommended for diagnosis and possible decompression of the optic chiasm. The final pathology was consistent with metastatic, high grade adenocarcinoma, supported by positive mucicarmine stain for mucin, positive immunohistochemical stain for CAM 5.2 and CK7 and negative immunohistochemical stains for the pituitary transcription factors, PIT-1 and SF-1. Conclusion: We report the second case in the literature of adenocarcinoma of the head and neck to the pituitary gland. In our case, radiological appearance of the tumor together with patient’s malignancy history led to the consideration of a pituitary metastasis. Tumors invading the cavernous sinus and causing internal carotid artery compression are rarely pituitary adenomas (2). Presence of these imaging features in patients with known risk factors for malignancy should raise suspicion for pituitary metastasis. The route of spread from the masseteric space to the sellar region remains unclear. Tumor metastasis can occur through direct invasion, hematogenous spread and perineural spread. Hematogenous spread and/or perineural spread along the trigeminal nerve are the most likely routes of metastasis in this case. Reference: (1)Javanbakht A, D’Apuzzo M, Badie B, Salehian B. Pituitary metastasis: A rare condition. Endocr Connect 2018; 7(10):1049-1057. PMID: 30139817. (2)Molitch ME et al (2012) Tumors invading the cavernous sinus that cause internal carotid artery compression are rarely pituitary adenomas. Pituitary 15(4):598–600

Manual Carotid Compression is a Viable Alternative for Reduction of Cerebral Microemboli.

Stroke is a devastating complication of cardiovascular surgeries, and the risk is particularly high for those requiring cardiopulmonary bypass (CPB). Embolic particles generated during the unclamping of the aortic cross-clamp may enter the cerebral circulation, lodging in small vessels. External manual compression of the carotid arteries is a non-invasive technique that has been proposed for cerebral protection during CPB procedures but is not widely deployed. The aim of this study is to assess the potential for cerebral emboli reduction with carotid compression using an in vitro model. Experiments were performed with a glass aortic arch model in a mock cardiovascular circuit. Small fluorescent particles were released into the circulation with and without carotid compression, and the particles visualized in the aortic midplane. The number of particles in the aorta and arch branch vessels were counted from the images before, during and following the release of carotid compression for durations of 10, 15 and 20s. A gamma variate function was fit to the data to describe the bolus dynamics. Carotid compression for 10 s reduces the number of embolic articles entering the carotid arteries by over 75%. A compression duration of 15-20s does not result in greater particle reduction than one of 10s. Brief compression of the common carotid arteries during cardiovascular interventions has the potential to dramatically reduce the number of cerebral emboli and should be investigated further.

Imaging and Intervention in Internal Carotid Artery Pseudoaneurysm Secondary to Retropharyngeal Abscess.

Vascular complications secondary to retropharyngeal abscess are rarely encountered in the post antibiotic era and include compression of internal carotid artery (ICA), infective arteritis and pseudoaneurysm formation. Post infectious ICA pseudoaneurysm formation is reported predominantly in the paediatric age group and rare in adults. We report a case of retropharyngeal abscess complicated by ICA pseudoaneurysm in an adult successfully managed by endovascular approach.

New forms of vascular pathology: stylocarotid, hyoid-carotid, thyroid-carotid and stylo-jugular syndromes

For the first time the possibility of ultrasound diagnostics of stylocarotid, hyoid-carotid, thyroid-carotid and stylo-jugular syndromes is shown in patients with impaired cerebral circulation.The necessity of reconstruction of bone-cartilage transitional structures with standard MR/CT angiography is justified.Abnormal structures of the styloid process such as elongation or curvature, the hyoid bone or thyroid cartilage, often in combination with ossification of the stylohyoid or stylomandibular ligaments can cause compression of the internal carotid artery with the formation of dissection, intramural hematoma, stenosis, occlusions and aneurysms. Additionally, symptoms of impaired cerebral circulation start to develop in these patients. Extravasal compression by the styloid process and/or the transverse process of the first cervical vertebra can reduce the blood flow in the internal jugular vein. But only standard vascular imaging is performed in cases of cerebral circulatory disorders, without reconstruction of adjacent bone and cartilage structures. Therefore, there is insufficient data on compression lesions of the neck vessels. Moreover, there is lack of data on ultrasound imaging of vascular Eagle syndrome. The article presents authors` experience of ultrasound diagnostics of this pathology in combination with clinical, angiographic and CT nuances.