Internal carotid artery dissection associated with an elongated hyoid bone in a patient with vascular Ehlers-Danlos syndrome.

Hyoid bone-related carotid injury is a rare cause of neurovascular events. This report describes a case of a young, healthy male presenting with neck pain followed by left-sided hemiparesis. The patient was diagnosed with a transient ischaemic attack attributed to structural damage of the vascular surface of the right internal carotid artery as a direct result of continuous compression by an elongated hyoid bone. We describe a successful diagnosis using a series of manoeuvres during a six-vessel cerebral angiogram. Genetic testing later confirmed the diagnosis of vascular Ehlers-Danlos syndrome.

How I do it: operative nuances of the Encephalo-Duro-Mio-Synangiosis (EDMS) technique for pediatric moyamoya disease and syndrome.

BACKGROUND: Moyamoya disease, a progressive occlusive arteriopathy mainly affecting the supraclinoid internal carotid artery, leads to abnormal "Moyamoya vessels" and ischemic events in children due to decreased cerebral blood flow. Surgery, especially indirect revascularization, is suggested for pediatric Moyamoya cases. METHOD: We present the Encephalo-Duro-Mio-Synangiosis (EDMS) technique, illustrated with figures and videos, based on 14 years' experience performing 71 surgeries by the senior author (SGJ) and the Moyamoya Interdisciplinary Workteam at "Prof. Dr. J. P. Garrahan" Pediatric Hospital. CONCLUSION: EDMS is a simple and effective treatment for Moyamoya disease, enhancing procedure precision and safety, reducing associated risks, complications, and improving clinical outcomes.

Accuracy of duplex ultrasonography versus angiotomography for the diagnosis of extracranial internal carotid stenosis.

INTRODUCTION: Internal carotid artery (ICA) stenosis causes about 15% of ischemic strokes. Duplex ultrasonography (DUS) is the first line of investigation of ICA stenosis, but its accuracy varies in the literature and it is usual to complement the study with another more accurate exam when faced with significant stenosis. There is a lack of studies that compare DUS with angiotomography (CTA) in the present literature. METHODS: we performed an accuracy study, which compared DUS to CTA of patients in a tertiary hospital with a maximum interval of three months between tests. Patients were selected retrospectively, and two independent and certified vascular surgeons evaluated each image in a masked manner. When there was discordance, a third evaluator was summoned. We evaluated the diagnostic accuracy of ICA stenosis of 50-94% and 70-94%. RESULTS: we included 45 patients and 84 arteries after inclusion and exclusion criteria applied. For the 50-94% stenosis range, DUS accuracy was 69%, sensitivity 89%, and specificity 63%. For the 70-94% stenosis range, DUS accuracy was 84%, sensitivity 61%, and specificity 93%. There was discordance between CTA evaluators with a change from clinical to surgical management in at least 37.5% of the conflicting reports. CONCLUSION: DUS had an accuracy of 69% for stenoses of 50-94% and 84% for stenoses of 70-94% of the ICA. The CTA analysis depended directly on the evaluator with a change in clinical conduct in more than 37% of cases.

Cochleo-carotid dehiscence as a third window syndrome: a review of an unusual presentation and its clinical-radiological approach / Dehiscencia cócleo-carotídea como síndrome de la tercera ventana: una revisión de una presentación inusual y su enfoque clínico-radiológico

When examining patients who present both fluctuating auditory symptoms and vestibular symptoms, which can be mistaken for an ear disease, it is important to consider cochlear-carotid fistula as a condition that could generate these clinical manifestations. In this case, additional imaging tests should be performed to demonstrate the lack of continuity at that level and rule out other entities. The objective is to describe the cochleo-carotid dehiscence in a 39-year-old woman and propose it as a possible etiology of a third window syndrome, in order to discuss the relationship between clinical findings, neurotologic examination, and magnetic resonance imaging.

Al examinar a pacientes que presentan síntomas auditivos fluctuantes y síntomas vestibu-lares, que pueden ser confundidos con una enfermedad del oído, es importante considerar la fístula coclear-carotídea como una condición que podría generar estas manifestaciones clínicas. En este caso, se deben realizar pruebas de imagen adicionales para demostrar la falta de continuidad en ese nivel y descartar otras entidades. El objetivo es describir la dehiscencia cocleo-carotídea en una mujer de 39 años y proponerla como una posible etiología del síndrome de la tercera ventana, con el fin de discutir la relación entre los hallazgos clínicos, el examen neurotológico y la resonancia magnética.

Revisiting carotid endarterectomy: Neobulb technique using external carotid artery as a patch.

OBJECTIVES: This study describes an alternative carotid bifurcation endarterectomy technique in which the external carotid artery is used as a suture patch. METHODS: Charts of ten patients with atherosclerotic carotid stenosis that were treated using the neobulb technique between 2002 and 2019 were reviewed. RESULTS: No major surgical adverse event was observed in the postoperative assessments. No postoperative common or internal carotid stenosis was observed in the mid- or long-term follow-up. CONCLUSIONS: The neobulb technique allows carotid endarterectomy closure without a synthetic or venous patch, using the external carotid artery as an autologous patch, while preserving distal flow into the external carotid artery branches.

Agenesis of the internal carotid artery associated with intracranial aneurysms: Endovascular treatment and intraoperative complications management.

Agenesis of the internal carotid artery (ICA) is a rare condition, whereas the association of this condition and the presence of intracranial aneurysms is higher in comparison to patients with normal vasculature. Endovascular treatment of this particular subgroup of patients has been described, but complications associated during treatment have not. Herein, we describe the endovascular treatment of intracranial aneurysms in two cases complicated with coil protrusion and in-stent thrombosis in the setting of agenesis of the ICA which were treated successfully without clinical compromise. One-year follow-up digital subtraction angiography demonstrated the complete obliteration of both aneurysms. In most of the cases, coil protrusion does not require further intervention; nevertheless, in the setting of ICA agenesis, stent placement is a potential alternative. In-stent thrombosis should be treated promptly with the available tools, in our case intra-arterial Alteplase reperfused the parent vessel.

Agenesis of the right internal carotid artery and aqueductal stenosis in a child with hydrocephalus, the role of endoscopic third ventriculostomy: a case report.

Agenesis of the internal carotid artery (aICA) is a rare congenital vascular condition that can affect one or both sides of the patient. Most patients remain asymptomatic, but ischemic/hemorrhagic stroke, intracranial aneurysm, and other neurologic findings can occur. CT scan can demonstrate the absence of the bony carotid canal and helps to differentiate a complete aICA from aplasia or hypoplasia. The association of aICA and aqueductal stenosis (AS) has never been reported in the literature. We report the case of a 9-year-old with agenesis of the right ICA associated with AS and hydrocephalus, which was treated successfully with an endoscopic third ventriculostomy (ETV). We review the literature looking for the association of the clinical findings and the evolution of the patient.

Presumed normal hemodynamic values of the arteries in the final third period of gestation in bitches

Background: Doppler ultrasonography enables the investigation of vascular blood flow indexes in gestational assessment,being able to detect vascular resistances that can affect fetal and maternal circulation, such as cases of placental insufficiency, associated with fetal cerebral oxygenation deficit and fetal distress. The study aims to assume hemodynamicallynormal values in the final third of gestation in bitches, of the umbilical, uteroplacental, middle cerebral and internal carotidarteries, correlating the obtained Doppler velocimetric indexes, for the assessment of the feto-placental circulation, andprediction of fetal viability indexes, fetal centralization and probable date of delivery.Materials, Methods & Results: Thirty healthy bitches were examined in the final third of gestation (40-60 days). Thesewere evaluated by Doppler ultrasonography at 2 times (T): T1: between 40-50 days; T2: between 51-60 of gestation.At each time point, the peak systolic velocities (PSV) and end-diastolic velocities (EDV) used to obtain the pulsatility(IP) and resistivity (IR) indexes of the umbilical, uteroplacental, middle cerebral and internal carotid arteries of fetuseswere evaluated. Also, the systole/diastole (S/D) ratio of these vessels was evaluated. The data obtained were subjected toanalysis of variance and Tukey test, using a P value equal to 5%. A significant difference was observed between velocitiesand Doppler velocimetric indexes between the 2 phases of the gestational final third in all studied vessels. There was anincrease in the values of PSV and EDV and a decrease in the indexes, as the probable date of delivery approached. Theanalysis of the umbilical cord IR showed an increase from P1 to P2 (P < 0.05), while the IP decreased at the same time.For all studied variables there was a statistically significant difference (P < 0.05). In the uteroplacental...(AU)

Anterior cerebral artery trifurcation with infraoptic origin and contralateral A1 segment absence.

PURPOSE: To describe an uncommon anatomical variant of the anterior cerebral artery and the imaging findings. METHODS: A 2-month-old infant with known history of atrial and ventricular septal defects was admitted to our institution for evaluation and management of growth failure. Given the clinical presentation and medical history, magnetic resonance imaging (MRI) of the brain and MR angiography (MRA) were performed to exclude congenital hypopituitarism and any vascular abnormality. RESULTS: Time of flight MRA revealed trifurcation of the anterior cerebral artery with one of the vessels arising from the ophthalmic segment of the right internal carotid artery; thus, the A1 segment of the left anterior cerebral artery (ACA) was absent, and the right posterior cerebral artery (PCA) had a fetal origin. CONCLUSION: Anatomical variants of the cerebral circulation are asymptomatic and found incidentally. Knowledge of these variants and careful examination of CT/MRI angiograms are important for diagnosis and treatment planning.

Anatomical relationship of pterygoid process pneumatization and vidian canal.

INTRODUCTION: The vidian canal acts as landmark for the identification of the petrous carotid artery, especially during extended endoscopic endonasal approaches in cranial base surgeries. In order to localize the canal and to understand the relationship of pneumatization of pterygoid process to the type of vidian canal, this study was designed. OBJECTIVES: The objective was to describe the anatomical relationship of pneumatization of the pterygoid process with types of vidian canal. The length of vidian canal, relationship to medial plate of pterygoid process and relationship to the petrous part of internal carotid artery were evaluated. METHODS: Head computer tomography scans of 52 individuals for suspected paranasal pathology were studied. The degree of sphenoid sinus pneumatization, pterygoid process pneumatization and types of vidian canal (type 1, 2 and 3) were noted. The length of vidian canal, distance from the plane of medial pterygoid plate and relation of vidian canal to the junction of petrous and Gasserian (ascending) part of internal carotid artery was noted. RESULTS: 46 (92%) sphenoid sinuses were of the sellar variety. Out of 104 sides that were studied, 57 sides demonstrated a pneumatised pterygoid process and 47 were not pneumatised. In 49 sides (47.1%) the vidian canal was on the same plane as that of the medial pterygoid plate in the coronal section. The vidian canal partially protruded into the sphenoid sinus (type 2) was the most common type (50.9%), found both on right and left sides. There is a statistically significant association between the pterygoid process pneumatization and occurrence of type 2 and type 3 vidian canal configuration. The average length of the vidian canal was 16.16 ±â€¯1.8 mm. In 96 sides, the anterior end of vidian canal was inferolateral to petrous part of internal carotid artery in the coronal plane. CONCLUSION: Pneumatization of the pterygoid process indicates either type 2 or type 3 vidian canal configuration.

Manifestações oftalmológicas em paciente com aneurisma gigante de carótida interna / Ophthalmological manifestation in patient with gigantic aneurysm of the internal carotid

RESUMO Os aneurismas intracranianos são dilatações em segmentos arteriais que irrigam o sistema nervoso central. Acometem 2% da população e as alterações oftalmológicas podem ser as primeiras manifestações do quadro. O objetivo deste relato foi descrever um caso de aneurisma de artéria carótida interna que cursou com restrição da movimentação ocular, alteração do reflexo fotomotor, ptose palpebral, dor facial e cervical. O diagnóstico foi confirmado pela identificação do aneurisma por meio do exame de angiografia cerebral. Foi realizado teste de oclusão por balão, cujo resultado positivo possibilitou a oclusão total da artéria carótida interna por meio de ligadura cirúrgica, procedimento este realizado com sucesso.

ABSTRACT Intracranial aneurysms are dilations in segments of the arteries that irrigate the central nervous system. They affect 2% of the population and the ophthalmologic disorders may be the first evidence in the clinical examination. The aim of the report is to describe a case of an internal carotid artery aneurysm that showed restrictions of ocular movements, change of pupillary light reflex, palpebral ptosis, facial, and cervical pain. This diagnosis was confirmed by the identification of the aneurysm through angiography. A balloon occlusion test was performed, and its positive result made a complete occlusion of the Internal Carotid Artery possible through surgery ligation, procedure that was successful.

Presumed normal hemodynamic values of the arteries in the final third period of gestation in bitches

Background: Doppler ultrasonography enables the investigation of vascular blood flow indexes in gestational assessment,being able to detect vascular resistances that can affect fetal and maternal circulation, such as cases of placental insufficiency, associated with fetal cerebral oxygenation deficit and fetal distress. The study aims to assume hemodynamicallynormal values in the final third of gestation in bitches, of the umbilical, uteroplacental, middle cerebral and internal carotidarteries, correlating the obtained Doppler velocimetric indexes, for the assessment of the feto-placental circulation, andprediction of fetal viability indexes, fetal centralization and probable date of delivery.Materials, Methods & Results: Thirty healthy bitches were examined in the final third of gestation (40-60 days). Thesewere evaluated by Doppler ultrasonography at 2 times (T): T1: between 40-50 days; T2: between 51-60 of gestation.At each time point, the peak systolic velocities (PSV) and end-diastolic velocities (EDV) used to obtain the pulsatility(IP) and resistivity (IR) indexes of the umbilical, uteroplacental, middle cerebral and internal carotid arteries of fetuseswere evaluated. Also, the systole/diastole (S/D) ratio of these vessels was evaluated. The data obtained were subjected toanalysis of variance and Tukey test, using a P value equal to 5%. A significant difference was observed between velocitiesand Doppler velocimetric indexes between the 2 phases of the gestational final third in all studied vessels. There was anincrease in the values of PSV and EDV and a decrease in the indexes, as the probable date of delivery approached. Theanalysis of the umbilical cord IR showed an increase from P1 to P2 (P < 0.05), while the IP decreased at the same time.For all studied variables there was a statistically significant difference (P < 0.05). In the uteroplacental...

Association between internal carotid artery calcifications detected as incidental findings and clinical characteristics associated with atherosclerosis: A dental volumetric tomography study.

PURPOSE: To evaluate the presence of calcifications in the internal carotid artery (ICA) in cone-beam computed tomography (CBCT), and to verify the association of these findings with sex, age, dental condition, and risk factors associated with vascular disorders. METHODS: The CBCT scans used in this study were obtained from the database of a private dental clinic requested for the planning of rehabilitation with dental implants. The selection criteria were patients aged 40 years and above. Out of a pool of 1176 CBCT examinations, a total of 284 scans of adult patients were evaluated by two blinded observers. Data were collected from patients' medical records. RESULTS: ICA calcifications were present in 63.0% of the examinations. Most calcifications were in the intracranial pathway (166). Despite being present in a smaller number 57 (C1), extracranial calcifications were more severe. Spearman's ρ coefficients (rS) indicated that the number of missing teeth was directly associated with the presence of calcifications (p = 0.042) and severity (p = 0.020). The age variable also had a direct relationship with the presence of calcifications (p ≤ 0.0001), increasing its frequency and severity over the years. In addition, hypertension (p = 0.036) and use of antihypertensive drugs (p = 0.015) were directly associated. CONCLUSIONS: There is a high occurrence of ICA calcifications in CBCT as incidental findings in adult patients, and it is directly associated with age, number of missing teeth and hypertension.

Effect of internal carotid artery aberrations on the distance between styloid process and carotid artery / Efecto de las variaciones de la arteria carótida interna en la distancia entre el proceso estiloides y la arteria carótida

SUMMARY: The objective of this study was to evaluate the role of the variations of carotid artery course on the relationship between styloid process (SP) and internal carotid artery (ICA). Carotid CT angiography scans of 170 patients were retrospectively evaluated. The variability of the course of ICA were classified. The length and medial angulation of the SP were measured on coronal 3D images. On axial images, the shortest distance between the bone edge of the SP and ICA were measured. The distance between SP and ICA among the course patterns of carotid artery were compared statistically. In the comparison of distances between SP and ICA with respect to the course of ICA, the difference between straight and curving (p <0.001) was statistically significant. Curving caused the separation of ICA and SP. The highest and the shortest distance was at the curving and coiling group, respectively. We found that SP-ICA distance has a positive and negative correlation with SP angle (p<0.001) and SP length (p<0.001), respectively. The course of ICA is one of the major determinants affecting the relationship of ICA and SP. The curving pattern of ICA has a tendency to increase the distance between SP and ICA.

RESUMEN: El objetivo de este estudio fue evaluar el rol de las variaciones que tiene el curso de la arteria carótida en la relación entre el proceso estiloides (PE) y la arteria carótida interna (ACI). Se evaluaron retrospectivamente angiografías por tomografía computarizada carotídea de 170 pacientes. Se clasificó la variabilidad del curso de ACI. Se midieron en imágenes coronales y en 3D la longitud y la angulación medial del PE. En las imágenes axiales, se midió la distancia más corta entre el margen del PE y la ACI. Se comparó estadísticamente la distancia entre PE y la ACI entre los patrones de trayecto de la arteria carótida. La comparación de las distancias entre PE y la ACI respecto al curso de ACI, fue estadísticamente significativa, siendo la diferencia entre arterias recta y curva (p <0,001). La arteria curva provocó la separación de la ACI y del PE. Las mayores y menores distancias estaban en el grupo de arterias curvas y enrolladas, respectivamente. La distancia PE-ACI tiene una correlación positiva y negativa con el ángulo PE (p <0,001) y la longitud del PE (p <0,001), respectivamente. El curso de la arteria carótida interna es uno de los principales determinantes que afectan la relación con el proceso estiloides. El patrón de curva de la ACI tiende a aumentar la distancia entre PE y la propia arteria arteria.