Concept: External carotid artery
There are considerable variations in the anatomy of the human ophthalmic artery (OphA), such as anomalous origins of the OphA and anastomoses between the OphA and the adjacent arteries. These anatomical variations seem to attribute to complex embryology of the OphA. In human embryos and fetuses, primitive dorsal and ventral ophthalmic arteries (PDOphA and PVOphA) form the ocular branches, and the supraorbital division of the stapedial artery forms the orbital branches of the OphA, and then numerous anastomoses between the internal carotid artery (ICA) and the external carotid artery (ECA) systems emerge in connection with the OphA. These developmental processes can produce anatomical variations of the OphA, and we should notice these variations for neurosurgical and neurointerventional procedures.
Embozene® is a new neuroembolizing microsphere used to reduce intraoperative bleeding for head and neck tumours. We report a case of iatrogenic ophthalmic artery occlusion after Embozene® embolization of the external carotid artery (ECA).
The anterior clinoid process (ACP) is critically related to the clinoidal portion of the internal carotid artery (ICA). The deep location of the ACP makes treatment of vascular and neoplastic lesions related to the ACP challenging. Removal of the ACP is advocated to facilitate treatment of such lesions. However injury to the clinoidal ICA remains a potential and dreadful complication of ACP removal. The aim of this study was to demonstrate an endoscopic assisted technique to perform intradural removal of the ACP via a pterional approach with continuous visualization of the clinoidal ICA.
Transient monocular blindness and amaurosis fugax are umbrella terms describing a range of patterns of transient monocular visual field loss (TMVL). The incidence rises from ≈1.5/100,000 in the third decade of life to ≈32/100,000 in the seventh decade of life. We review the vascular supply of the retina that provides an anatomical basis for the types of TMVL and discuss the importance of collaterals between the external and internal carotid artery territories and related blood flow phenomena. Next, we address the semiology of TMVL, focusing on onset, pattern, trigger factors, duration, recovery, frequency-associated features such as headaches, and on tests that help with the important differential between embolic and non-embolic etiologies.
: In transarterial embolization of anterior cranial fossa and tentorial dural arteriovenous fistula (DAVF), acute angulation of the feeding artery off the internal carotid artery (ICA) may render stable distal catheterization and, therefore, successful transarterial treatment difficult. In some anatomic dispositions, following selection of the feeding artery, subsequent forward force may lead to prolapse of the microcatheter into the ICA rather than advancing it into either the ophthalmic artery or the meningohypophyseal trunk.
Pulmonary embolism and fatal stroke in a patient with severe factor XI deficiency after bariatric surgery.
- Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis
- Published over 5 years ago
We report the case of a 40-year-old woman with a severe factor XI (FXI) deficiency who died from a stroke due to bilateral internal carotid arteries occlusion after a laparoscopic gastric bypass (bariatric surgery). This stroke was probably secondary to a pulmonary embolism with a paradoxical embolism through a previously unknown foramen ovale. This woman who had one severe episode of bleeding before the bypass received for the intervention a single infusion of 27 U/kg of FXI concentrate. A careful evaluation of the bleeding and thrombotic risk was performed before surgery, and despite all preventive measures, this tragic event occurred. The aim of this report is to alert medical teams to carefully balance the benefit-risk of such an intervention in a patient with a severe FXI deficiency.
Post-traumatic Amaurosis Secondary to Paraophthalmic Internal Carotid Artery Pseudoaneurysm Treated With Pipeline Embolization Device
- Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society
- Published over 4 years ago
: During evaluation for monocular visual loss, a 48-year-old woman was found to have a posttraumatic paraophthalmic internal carotid artery (ICA) pseudoaneurysm. She underwent reconstruction of the ophthalmic segment of the right ICA with a Pipeline embolization device but her vision did not return.
BACKGROUND: Endovascular treatment of intracranial aneurysms relies on coaxial catheter support systems to provide safe and stable access. Large-bore distal intracranial catheters have become necessary for aneurysm treatment with flow diverting devices including the Pipeline embolization device (PED). These catheters must accommodate 0.027 inch microcatheters, be supple enough to track distally and be able to provide sufficient support for manipulations required for PED deployment. METHODS: A single-center aneurysm database was reviewed to identify patients who underwent anterior circulation aneurysm embolization with the PED while using the Navien distal intracranial catheter. Data were collected regarding the equipment used, cervical internal carotid artery (ICA) tortuosity, intraprocedural Navien positions and periprocedural complications. RESULTS: The Navien catheter (5 Fr, 0.070 inch outer diameter, 0.058 inch inner diameter, 115 cm) was used in 78 cases of anterior circulation PED. It was tracked into position over a Marksman microcatheter in 76 of the 78 cases (97%). The final catheter tip position was in the cervical ICA (1/78, 1%), petrous ICA (23/78, 30%), proximal cavernous ICA (48/78, 62%), distal cavernous/clinoidal ICA (3/78, 4%), supraclinoid ICA (2/78, 2%) and the M1 segment (1/78, 2%). In each case the catheter was tracked to its desired position (100% clinical success) despite significant proximal vessel tortuosity in 34 cases (44%). No clinically significant catheter-related complications occurred. CONCLUSIONS: The Navien intracranial catheter is an important component of the triaxial system for embolization of cerebral aneurysms with the PED. This catheter is highly trackable to distal positions, atraumatic and provides sufficient support for the microcatheter manipulations used during typical PED deployments.
All previously documented regional anesthesia procedures for carotid artery surgery routinely require additional local infiltration or systemic supplementation with opioids to achieve satisfactory analgesia because of the complex innervation of the surgical site. Here, we report a reliable ultrasound-guided anesthesia method for carotid artery surgery. High-resolution ultrasound-guided regional anesthesia using a 12.5-MHz linear ultrasound transducer was performed in 34 patients undergoing carotid endarterectomy. Anesthesia consisted of perivascular regional anesthesia of the internal carotid artery and intermediate cervical plexus block. The internal carotid artery and the nerves of the superficial cervical plexus were identified, and a needle was placed dorsal to the internal carotid artery and directed cranially to the carotid bifurcation under ultrasound visualization. After careful aspiration, local anesthetic was spread around the internal carotid artery and the carotid bifurcation. In the second step, local anesthetic was injected below the sternocleidomastoid muscle along the previously identified nerves of the intermediate cervical plexus. The necessity for intra-operative supplementation and the conversion rate to general anesthesia were recorded. Ultrasonic visualization of the region of interest was possible in all cases. Needle direction was successful in all cases. Three to five milliliters of 0.5% ropivacaine produced satisfactory spread around the carotid bifurcation. For intermediate cervical plexus block, 10 to 20 mL of 0.5% ropivacaine produced sufficient intra-operative analgesia. Conversion to general anesthesia because of an incomplete block was not necessary. Five cases required additional local infiltration with 1% prilocaine (2-6 mL) by the surgeon. Visualization with high-resolution ultrasound yields safe and accurate performance of the block. Because of the low rate of intra-operative supplementation, we conclude that the described ultrasound-guided perivascular anesthesia technique is effective for carotid artery surgery.
OBJECTIVE: Differentiation between an occluded and a patent extracranial internal carotid artery (ICA) is crucial in the diagnostic workup of patients with acute ischemic stroke; particularly in patients eligible for endovascular treatment. We report neurological and radiological findings of cases in which CTA in the acute phase incorrectly revealed an occlusion of the ICA. METHODS: In our image data base of 54 patients with acute ischemic stroke eligible for endovascular treatment, we searched for patients with an occluded extracranial ICA on CTA whereas DSA proved that this artery was patent. Of these patients, all available images were re-examined to investigate possible causes of these so-called pseudo-occlusions. RESULTS: We detected 6 patients (11%) with a pseudo-occlusion. The pseudo-occlusions on CTA were associated with reduced flow due to carotid T-occlusions (4 cases) or a combination of a high degree stenosis of the extracranial ICA and MCA occlusion (2 cases). CONCLUSION: CTA in the acute phase of ischemic stroke needs to be interpreted with severe caution, and in endovascular treatment decisions we should be aware that an extracranial ICA occlusion may be a false positive finding.