Branches Of Internal Carotid Artery Research Articles

Anatomia do circuito arterial do encéfalo em Tamanduá-mirim

O circuito arterial do encéfalo é de grande importância, pois é responsável pela vascularização do encéfalo, sendo este o principal órgão do sistema nervoso central e responsável por receber e processar informações. A espécie estudada foi escolhida por tratar-se de um mamífero pertencente à ordem Xenarthra e os integrantes dessa ordem são pouco estudados, devido à dificuldade de acesso a esses animais. Para desenvolver este trabalho, foram estudados cinco espécimes de Tamanduá-mirim (Tamandua tetradactyla). O material teve o sistema arterial injetado com látex Neoprene 650, corado em vermelho e fixado em solução aquosa de Formaldeído 10%, sendo posteriormente dissecados para sistematização dos vasos. O circuito arterial da base do encéfalo do tamanduá-mirim circunda o corpo mamilar, a fossa interpenduncular, o túber cinéreo, a hipófise e o quiasma óptico. A porção rostral desse circuito é caracterizada pelos ramos rostrais das artérias carótidas internas e a porção caudal é constituída pelas artérias comunicantes caudais e ramos caudais da artéria carótida interna. Esta espécie animal apresenta o tipo II de irrigação encefálica no qual existe a participação das artérias carótidas internas e do sistema vértebro-basilar para a formação do circuito arterial.

“…mAb®”: Can We Dream with a Future Monoclonal Antibody Therapy for Lumbar Canal Stenosis?

Preoperative embolization for intracranial meningiomas can cause tumor necrosis, reduce intraoperative blood loss, and facilitate surgery. This study aimed to evaluate the efficacy of tumor embolization using Embosphere microspheres for skull base meningiomas and analyze postembolization plain computed tomography (CT) and magnetic resonance imaging (MRI) scans to identify findings that could potentially predict treatment response.Between April 2014 and April 2020, 80 patients with skull base meningiomas presenting at our medical center underwent embolization with Embosphere microspheres. The effects of tumor embolization were evaluated through a comparison of postembolization plain CT and contrast-enhanced MRI.A total of 143 vessels (102 of 108 external carotid artery branches and 41 of 65 internal carotid artery branches) from 80 skull base meningiomas were embolized with Embosphere microspheres. Microspheres 100–300 μm in size were used in 2 cases, microspheres 300–500 μm in size were used in 12 cases, and microspheres 500–700 μm in size were used in 66 cases. Postembolization contrast-enhanced MRI showed reductions in enhancing lesions within the tumor in 55 of 80 cases. Postembolization plain CT scans showed high-density lesions within the tumor in 41 of 55 cases. Thus, reductions in enhancing lesions on postembolization contrast-enhanced MRI were statistically significantly associated with the presence of high-density lesions on postembolization plain CT (P < 0.001). Embolization-related neurological complications occurred in 3 cases.Embosphere microspheres are user friendly and effective embolic materials for the embolization of skull base meningiomas. Postembolization contrast-enhanced MRI and plain CT findings may be useful for evaluating the effects of tumor embolization.

E-010 Preoperative embolization of meningioma with dural branch of internal carotid artery

PurposeOne of the most important issues in the surgical treatment of large hypervascular meningiomas is the securing and coagulation of feeding arteries. However, securing the feeding artery prior to actual...

Anatomische Variante mit Ursprung der A. occipitalis aus der A. carotis interna

Carotid artery stenosis (CAS) is defined as the narrowing of the carotid artery lumen and is usually caused by calcification-associated constriction through an atherosclerotic process. As a result patients are faced with a main health-threatening danger, namely cerebrovascular accidents (CVAs), which can result in variable clinical presentation depending on the affected cortical areas and potentially lead to severe physical disability or even death. With appropriate indications CAS can be treated operatively by carotid endarterectomy (CEA). In order to minimize the risk of intraoperative complications and CVAs an exact surgical anatomical knowledge is essential. This includes the origin, course and anatomical variations of the internal and external carotid arteries which arise from the common carotid artery at the level of C3-C4. It is worth mentioning that the external carotid artery provides the blood supply to different cervical structures, whereas the internal carotid artery branches first after entering the skull. A detailed literature search revealed that there are only a few articles available describing the possible anatomical anomalies of the carotid arteries. This article presents the case of a 69-year-old patient with noticeable vascular variations, documented and observed during a CEA operation for symptomatic CAS and the medical relevance of these anatomical variations is discussed.

Dodecafluoropentane Emulsion Decreases Infarct Volume in a Rabbit Ischemic Stroke Model

Purpose To assess the efficacy of dodecafluoropentane emulsion (DDFPe), a nanodroplet emulsion with significant oxygen transport potential, in decreasing infarct volume in an insoluble-emboli rabbit stroke model. Materials And Methods New Zealand White rabbits (N = 64; weight, 5.1 ± 0.50 kg) underwent angiography and received embolic spheres in occluded internal carotid artery branches. Rabbits were randomly assigned to groups in 4-hour and 7-hour studies. Four-hour groups included control (n = 7, embolized without treatment) and DDFPe treatment 30 minutes before stroke (n = 7), at stroke onset (n = 8), and 30 minutes (n = 5), 1 hour (n = 7), 2 hours (n = 5), or 3 hours after stroke (n = 6). Seven-hour groups included control (n = 6) and DDFPe at 1 hour (n = 8) and 6 hours after stroke (n = 5). DDFPe dose was a 2% weight/volume intravenous injection (0.6 mL/kg) repeated every 90 minutes as time allowed. After euthanasia, infarct volume was determined by vital stains on brain sections. Results At 4 hours, median infarct volume decreased for all DDFPe treatment times (pretreatment, 0.30% [ P = .004]; onset, 0.20% [ P = .004]; 30 min, 0.35% [ P = .009]; 1 h, 0.30% [ P = .01]; 2 h, 0.40% [ P = .009]; and 3 h, 0.25% [ P = .003]) compared with controls (3.20%). At 7 hours, median infarct volume decreased with treatment at 1 hour (0.25%; P = .007) but not at 6 hours (1.4%; P = .49) compared with controls (2.2%). Conclusions Intravenous DDFPe in an animal model decreases infarct volumes and protects brain tissue from ischemia, justifying further investigation.

P-003 Intraarterial MR perfusion imaging of meningiomas: comparison to digital subtraction angiography

PurposeMeningiomas often benefit from preoperative embolization in order to reduce operative blood loss and associated morbidity. Intraarterial (IA) administration of contrast directly into the external carotid artery (ECA) and internal...

ENDOVASCULAR TREATMENT OF INTRACRANIAL DURAL ARTERIOVENOUS FISTULAE USING ONYX

An endovascular approach is often the first-line treatment of dural arteriovenous fistulae (DAVFs). Information on the use of Onyx (ev3 Neurovascular, Irvine, CA) for treating DAVFs, however, is limited. Therefore, we present our early experience, technical considerations, and complications associated with the use of Onyx for DAVF embolization. Twenty-eight patients with 29 DAVFs treated with Onyx embolization were included in this analysis. Hospital records, operative reports, and angiograms were reviewed and analyzed. Forty Onyx procedures, including 39 transarterial and 1 transvenous approaches, were performed. Fifty-one external carotid artery branches, 8 posterior meningeal artery branches, and 3 internal carotid artery branches were used for Onyx embolization. Branches of the middle meningeal artery were embolized 32 times, and the occipital artery was embolized 15 times. Twenty-one fistulae (72%) were cured angiographically with endovascular therapy. Transarterial embolization via the middle meningeal artery cured 12 DAVFs (41%). Four complications (9.7%) were recorded, including 3 transient (7.3%) and 1 permanent neurological deficits (2.4%). Follow-up imaging, which was available for 8 fistulae with angiographic cures, showed no evidence of recurrence. Transarterial Onyx embolization of external carotid artery branches, particularly the middle meningeal artery, offers a high likelihood of cure. This technique provides a safe and effective method of embolization with few side effects and complications. However, long-term follow-up is needed to establish its efficacy.

Novel Microcatheters for Selective Intra-Arterial Injection of Fluid in the Rat Brain

The internal carotid artery (ICA) in the rat has a single extracranial branch, which supplies the muscles of mastication. The rat ICA also has multiple intracranial branches including (from proximal to distal): multiple small perforating arteries which supply the hypothalamus and the anterior choroidal artery which supplies the choroid plexus and part of the basal ganglia. At the ICA terminus, the vessel bifurcates into the anterior and middle cerebral arteries. The purpose of this study was to demonstrate selective injection of ICA branches in the rat. Microcatheters (mucath1 and mucath2) were fabricated by plugging the tip of 169-mum outer diameter polyimide tubing and perforating the sidewalls. A 450-mum polydimethyl-siloxane cylinder was affixed to the distal tip of mucath2 but not mucath1. We evaluated the territory of mucath1 injection ex vivo using magnetization-prepared rapid acquisition of gradient echo MR imaging of brain specimens injected at necropsy. Territories of mucath1 and mucath2 injection were evaluated in vivo with dynamic susceptibility-weighted contrast-enhanced MR imaging. The territory of mucath2 also was evaluated in vivo with fused static microPET/T1 MR images performed after [(18)F] fluorodeoxyglucose ((18)FDG) injection. We evaluated additional catheterized and injected animals at 48 hours using physical examination, T2 MR images, and postmortem brain histologic specimens. Gadolinium-diethylene-triamine pentaacetic acid (Gd-DTPA) and (18)FDG injected through mucath1 selectively opacified the ipsilateral cerebral hemisphere, with no contralateral opacification. Gd-DTPA injected through mucath2 selectively opacified the territories of the hypothalamic perforating arteries, and anterior choroidal artery. There was no iatrogenic complication 48 hours after 20- to 25-minute injections performed with mucath1 or mucath2. We have developed 2 microcatheters which can be placed in the ICA for selective injection of its branches. One microcatheter selectively injects the ipsilateral cerebral hemisphere. The other selectively injects only the hypothalamus and lateral thalamus.

Spontaneous Involution of Nasopharyngeal Angiofibroma

There are several studies addressing regression of residual nasopharyngeal angiofibroma after surgery, but spontaneous regression of this tumor has been reported in only 2 cases. We present a case of nasopharyngeal angiofibroma that has involuted spontaneously in the last 5 years. The tumor had been diagnosed at another institute. Computed tomography taken in 2002 had revealed the tumor occupying the entire sphenoid sinus and the pterygopalatine fossa, extending to the cavernous sinus and the infratemporal fossa on the right side. The vascularization of the tumor had been mainly from the internal maxillary artery on angiography. The internal maxillary artery had been occluded with a coil, but branches of internal carotid artery could not be embolized due to high risks of complications. In 2004 the patient was seen at our institute, and this time, repeated angiography revealed rich vascularization from the internal carotid artery. The patient did not accept any treatment and was put on follow-up. He had no complaint in January 2007. The tumor was seen to disappear completely, except a little remnant at the right pterygopalatine fossa on computed tomography. This is the third reported case in the literature with spontaneous regression of nasopharyngeal angiofibroma.

The infra-optic course of the anterior cerebral arteries: an anatomical case report

Dear Sir, We have read with considerable interest the article by Peltier et al. on the infra-optic course of the anterior cerebral arteries. Since we have seen some mistakes, we would like to comment on Wgures and legends of the paper by Peltier et al. [2]. According to the classical anatomical textbooks and atlases, there is a confusion in legends of the Wgures [1, 3– 5]. In Figure 1, the connection between posterior cerebral artery and the artery named rPcoA has not been pointed out. At the caudal side, lumen of the rPcoA can be seen and this artery should be the right internal carotid artery. In our opinion, the smaller arterial branch coursing over the posterior perforated substance medial to the right internal carotid artery is rPcoA. The artery right caudal to the lAchA should be the left posterior communicating artery. Since the AchA is a branch of internal carotid artery, the artery named AcoA should be the internal carotid artery in Figure 2. But if we accept the legend AcoA as it is true, then the artery named McA should be the right anterior cerebral artery. In our opinion, the correction of these legends will make the article more comprehensible.

Pre-operative embolisation of internal carotid artery branches and pial vessels in hypervascular brain tumours

Pre-operative embolisation is an effective method used to reduce intra-operative bleeding and operative difficulty in hypervascular brain tumour surgery. However, embolisation of the internal carotid artery (ICA) and pial tumour feeding branches has certain limitations. From March 2000 to November 2006, 8 patients underwent superselective embolisation for hypervascular brain tumour. Seven tumours were extra-axial (6 meningiomas, 1 solitary fibrous tumour) and 1 was intra-axial (metastatic hepatocellular carcinoma). In all patients, feeding vessels from ICA branches or pial arteries were successfully embolised using superselective microcatheterisation. A provocative test was applied in 4 patients who had tumours adjacent to the motor cortex. Angiographic devascularisation was slight to extensive. Mean devascularisation on post-embolisation MRI ranged from 40 to 80% (mean 63.8%). One patient (12.5%) suffered an embolisation-related complication (loss of choroidal brush), but was not clinically worse because of the pre-existing blindness. Superselective embolisation of ICA branches or pial vessels should be performed if several conditions are met, especially angiographic findings, pre-existing neurologic deficits, provocative test, and technical feasibility. If the ICA embolisation for hypervascular tumour is successfully achieved, the bleeding loss and operative risk can be reduced.

Intraluminal suture occlusion and ligation of the distal branch of internal carotid artery: An improved rat model of focal cerebral ischemia-reperfusion

In order to evaluate a modified method of reversible middle cerebral artery occlusion (MCAo), 50 male Sprague–Dawley rats were subjected randomly to reperfusion series ( n = 30) with 3 h of MCAo followed by 69 h of reperfusion and permanent series ( n = 20) with 24 h of MCAo only. Based on Longa's method, experimental group with ligation of the distal branch of the internal carotid artery (ICA) around the intraluminal suture and control group without ligation were included. Behavioral functions were evaluated at 3 h after occlusion and during a 3-day period after MCAo in reperfusion series, or at 3 and 24 h after occlusion in permanent series. Infarct volume (IFV) was measured by the 2,3,5-triphenyl tetrazolium chloride (TTC) method at end time point in each series, and intraluminal thrombus formation in ICA of the reperfusion series was evaluated. In the experimental groups, a 100% incidence of infarction was shown in two series which was significantly higher than that in the control group (40% in reperfusion series and 50% in permanent series, p < 0.05). The total IFV and subcortical IFV in the experimental group was 174.9 ± 6.2 and 101.8 ± 2.6 mm 3 in reperfusion series and 321.8 ± 4.2 and 191.6 ± 7.5 mm 3 in permanent series, respectively, significantly larger than that in the control group ( p < 0.05). Meanwhile, the coefficient of variation of total IFV and subcortical IFV in the experimental group was dramatically smaller than that in the control group ( p < 0.05). Rats in the experimental groups were more severely impaired on neurobehavioral tests than that in the control groups ( p < 0.05), and showed longer duration of neurological deficits and slower recovery of functions. No thrombus or clot was observed in ICA of the reperfusion series. Reversible MCAo with ligation of the distal branch of ICA is proven to be a reliable and effective method with which consistently larger infarcts including subcortex lesions is yielded.

Anatomical flow phantoms of the nonplanar carotid bifurcation, Part II: Experimental validation with Doppler ultrasound

A nonplanar wall-less anatomical flow phantom of a healthy human carotid artery is described, the construction of which is based on a lost-core technique described in the companion paper (Part I) by Watts et al. (2006). The core was made by rapid prototyping of an idealized three-dimensional computer model of the carotid artery. Flow phantoms were built using these idealized non planar carotid artery bifurcations. Physiologically realistic flow waveforms were produced with resistance index values of 0.75, 0.72 and 0.63 in the common, external and internal carotid artery branches, respectively. Distension of the common carotid using M-mode imaging was found to be at 10% of diameter. Although differences in vessel diameter between the phantom and that of the original computer model were statistically significant ( p < 0.05), there was no difference ( p > 0.05) in measurements made on the lost-cores and those obtained by B-mode ultrasound on the resulting flow phantoms. In conclusion, it was possible to reliably reproduce geometrically similar anatomical flow phantoms that are capable of producing realistic physiological flow patterns and distensions. (E-mail: smeagher@staffmail.ed.ac.uk)

Direct sac puncture and N‐butyl cyanoacrylate embolization of medial canthal arteriovenous malformation supplied by the external carotid artery and the internal carotid artery branches

We report a periorbital arteriovenous fistula that was treated with direct sac puncture N-butyl cyanoacrylate embolization under controlled inflow and outflow. The efficacy of this technique in a periorbital lesion is discussed.

Preoperative Embolization of Brain Tumor with Pial Artery or Dural Branch of Internal Carotid Artery as Feeding Artery

This study evaluated the clinical usefulness of preoperative embolization of the pial artery or dural branch of the internal carotid artery (ICA) for brain tumor. Subjects comprised 17 patients with large hypervascular brain tumors who underwent preoperative selective embolization. Micro-catheters (2- or 1.7-F) and shapeable hydrophilic micro-guide wires were used for pial artery (branching from the posterior or anterior cerebral artery) or ICA dural branch embolization. Embolization was performed under digital subtraction fluoroscopy with Polyvinyl alcohol (PVA) particles (150-250 mm) and/or liquid coil.Tumor resection was performed immediately or the day after embolization. Digital subtraction angiography (DSA) before and after endovascular devascularization, blood loss during tumor resection, and clinical outcome were evaluated. All endovascular procedures were technically successful. Post-embolization DSA revealed either a disappearance or a marked decrease of the tumor stain in all cases. Control of intraoperative bleeding was easily accomplished, and intraoperative blood loss was low. Preoperative particle embolization of the feeding artery from the cortical artery or ICA dural branch is safe and effective as adjuvant therapy before tumor resection.

Pitfalls during the Embolization and Evaluation after the Embolization for the Skull Base Meningiomas

Pitfall during the embolization and evaluation after the embolization for skull base meningiomas supplied by meningeal arteries of internal carotid artery (ICA) are reported. This study includes 15 cases of skull base meningiomas (two males and 13 females) that supplied by meningeal branches of internal carotid artery. The preoperative embolization was performed by these feeders. MRI findings and serum levels of C-reactive protein (CRP) after the embolization were examined. In ten patients among 15 patients the meningeal branches of ICA were dominant feeders. In ten patients out of 15 patients, the embolization from the meningeal branches of ICA was possible. Eight patients out of these ten patients were suffered from high fever and increase of serum level of CRP after the embolization. During the embolization for skull base meningiomas, the existence of collateral pathways between the ICA system and external carotid artery system were identified. The increase of serum levels of CRP might be recognized in the patients that effective embolization were performed.

Carotid Blowout Treated by Direct Percutaneous Puncture of Internal Carotid Artery with Temporary Balloon Occlusion

Direct percutaneous puncture of a cervical carotid pseudoaneurysm for coil placement or acrylic embolization is described for the endovascular management of acute carotid blowout. However, direct puncture of the internal carotid artery (ICA) for the endovascular management of carotid blowout has not been described. We report a difficult case of acute carotid blowout syndrome in a patient who had radiation- induced occlusion of the right common carotid artery with vasculopathy and pseudoaneurysm in the right cervical ICA. Collaterals from the branches of the controlateral external carotid artery (ECA) anastomosed with branches of right ECA supplied the vasculopathy. We performed direct percutaneous puncture of the bulb of the right ICA using a spinal needle and placed fiber coils to occlude antegrade flow of the artery. During the injection of a mixture of N-butyl cyanoacrylate and lipiodol oil for embolization of the remaining carotid bulb, we transiently inflated an occlusion balloon in the controlateral common carotid artery to further arrest antegrade flow in the ICA. The vasculopathy and pseudoaneurysm of the right cervical ICA were successfully embolized, with preservation of the distal branches of the right ICA.

Proximal intracranial internal carotid artery branches: prevalence and importance for balloon occlusion test

The aim of this study was to determine the prevalence of angiographically identifiable skull base arterial branches that potentially serve as collateral conduits during a balloon occlusion test (BOT) of the internal carotid artery (ICA). The authors posited that neurological deficits in patients who had previously tolerated the occlusion test may be attributable to an unrecognized collateral support through these channels (operant during proximal ICA BOT) when permanent ICA occlusion was performed more distally. In 481 cases (962 ICAs), cerebral angiograms obtained during routine Wada testing were retrospectively reviewed. Two hundred sixty-one patients had at least one angiographically identifiable ICA branch; 109 patients had two or more branches. A meningohypophyseal branch of the cavernous ICA was identified on the right side in 108 patients and on the left in 122. A vidian artery originated from the petrous portion of the ICA on the right side in 58 patients and on the left in 85. The inferolateral trunk revealed itself as a branch of the cavernous ICA on the right side in 17 patients and on the left in 33. A caroticotympanic artery arose from a left cavernous ICA. A persistent trigeminal artery was situated on the right side in two patients and on the left in three. More than half of the patients had angiographically identifiable and perhaps hemodynamically significant skull base branches of the ICA, and approximately one quarter had more than one identifiable branch. The authors recommend that patients be screened during angiography studies performed prior to BOT in branches of the proximal intracranial ICA and that the site of BOT be moved distally if such branches are identified.

Características morfológicas da distribuição vascular cerebral de Sus scrofa Linnaeus (Mammalia, Artiodactyla)

O objetivo do presente estudo foi verificar a vascularização arterial do encéfalo do javali, Sus scrofa Linnaeus, 1758, Suidae, e comparar com outras espécies. Cinco machos e cinco fêmeas foram injetados com látex colorido. O suprimento arterial do encéfalo foi descrito e análises morfológicas foram feitas. Nesta espécie o circuito arterial do encéfalo é formado por ramos da artéria carótida interna, como: as artérias comunicantes caudais, o ramo rostral, as artérias cerebrais rostrais, e artérias comunicantes rostrais.

Endovascular treatment in direct carotid cavernous fistula.

Direct carotid cavernous fistula (CCF) is the most common types of arteriovenous fistula (AVF) in the craniofacial area and endovascular treatment is primarily indicated in managing the disease. CCFs are abnormal, direct communications between the internal carotid arteries (ICA) and the cavernous sinuses formed as a consequence of blunt head trauma1,2. They occur secondary to traumatic laceration of the internal carotid artery at the intracavernous segment or from rupture of intracavernous branches. AVFs supplied by external carotid artery and dural branches of ICA are traditionally called indirect, or dural arteriovenous fistula of the cavernous sinus and are totally different entity with different therapeutic strategy. To understand the clinical and angiographic features and to treat this lesion properly, knowledge of vascular anatomy of the skull base and clinical features of this disease are necessary. Angiographic evaluation of the lesion, therapeutic strategies, and treatment-related problems will be discussed.