Bilateral hypoplasia of the internal carotid arteries is a rare condition. The authors experienced two cases of bilateral hypoplasia of the internal carotid arteries. In one case, a 46-year-old female patient, presented with subarachnoid hemorrhage. Internal carotid angiograms showed right hypoplastic internal carotid artery and left agenetic internal carotid artery. An aneurysm, believed to be the source of the subarachnoid hemorrhage, took origin from the trunk of the basilar artery. In another case, a 48-year-old male, presented with semicomatous mentality. Brain CT demonstrated intracranial hemorrhage on the parasylvian area, and high density on the basal cistern, quadrigerminal cistern and temporal horn of left lateral ventricle. Initially, aortic arch injection did not visualized the origin of the common carotid arteries. It revealed only the vertebral arteries and both external carotid artery originating from each vertebral artery. A selective left vetebral artery study demonstrated a communication between the hypertrophied basilar artery and the posterior cerebral arteries. The anterior and middle cerebral vessels, in turn, were opacified through the circle of Willis, via the posterior communicating arteries. In addition, an aneurysm, believed to be the sourse of the subarachnoid hemorrhage, took origin from the posterior cerebral artery. The cases of the bilateral hypoplasia of internal carotid artery with intracranial aneurysm are reported as above, together with literature review.
Aneurysm ; Animals ; Aorta, Thoracic ; Arteries ; Basilar Artery ; Brain ; Carotid Artery, Common ; Carotid Artery, External ; Carotid Artery, Internal* ; Circle of Willis ; Collateral Circulation ; Female ; Horns ; Humans ; Intracranial Aneurysm* ; Intracranial Hemorrhages ; Lateral Ventricles ; Male ; Middle Aged ; Posterior Cerebral Artery ; Subarachnoid Hemorrhage ; Vertebral Artery

In order to study the vascular manifestation of Behcet's disease, authors analized retrospectively the radiological and clinical features of 22 patients who were diagnosed as vasculo-Behcet's disease. The angiographic findings were aneurysm formation and occlusion of artery and vein, Aneurysm formations were found at common carotid artery (3 cases), abdominal aorta (2 cases), aortic arch (2 cases), innominate artery (2 cases) etc. Arterial occlusions were found at pulmonary artery (2 cases), subclavian artery (1 cases), brachial artery (1 case), common femoral artery (1 case) etc. Venous occlusions were found at the veins of the lower extremities including superficial femoral vein (18 cases), IVC (2 cases), SVC (1 case), and lateral sinus (1 case). The clinical features were similar to that of Behcet's disease without vascular involvement, but incidence of vascular involvement was more common in men and interval between the onset of the disease and vascular symptoms was 1-16 years(77%) and common associated symptoms were oral ulcers(59%) and skin lesions(55%). Angiographically the morphological featured of vasculo-Behcet's disease are not specific, but vascular radiologist must be aware of vascular involvement by Behcet's disease in differential diagnosis when occlusive changes in the venous or arterial tree, or aneurysm formation are seen in young patients.
Aneurysm ; Aorta, Abdominal ; Aorta, Thoracic ; Arteries ; Brachial Artery ; Brachiocephalic Trunk ; Carotid Artery, Common ; Diagnosis, Differential ; Femoral Artery ; Femoral Vein ; Humans ; Incidence ; Lower Extremity ; Male ; Pulmonary Artery ; Retrospective Studies ; Skin ; Subclavian Artery ; Transverse Sinuses ; Trees ; Veins

BACKGROUND: Agenesis of the common carotid artery (CCA) resulting in separation of the origin of the external carotid artery (ECA) and internal carotid artery (ICA) from the aortic arch is rare. Fewer than 25 cases have been reported, and correlative ultrasound data were available for only 1 of them. CASE REPORT: A 52-year-old woman visited the hospital with a 3-day history of vertigo and headache. Color-coded duplex ultrasonography performed to evaluate the carotid and vertebral arteries revealed a normal configuration on the left side. However, the right CCA could not be found; instead, there were two vessels of approximately equal size in close proximity to each other. The cerebral angiographic findings were consistent with the ultrasonographic findings. The ECA and ICA originated directly from the brachiocephalic trunk, and the ECA arose proximal to the ICA. CONCLUSIONS: The ultrasonographic findings revealed absence of the CCA, the ECA and ICA originating separately from the aortic arch. Color-coded duplex ultrasonography appears to be an effective and sensitive method for detecting absence of the CCA. These findings should help to further our understanding of the embryologic development of the carotid arteries.
Angiography ; Aorta, Thoracic ; Brachiocephalic Trunk ; Carotid Arteries ; Carotid Artery, Common ; Carotid Artery, External ; Carotid Artery, Internal ; Female ; Headache ; Humans ; Middle Aged ; Vertebral Artery ; Vertigo

BACKGROUND: In a condition of microgravity, arteries of upper body part are exposed to relative hypertensive stress, which is induced by headward fluid shift. We already have reported the increase of monocyte adhesion and intercellular adhesion molecule-I (ICAM-I) expression in carotid artery and thoracic aorta in the simulated microgravity. The purpose of this study was to identify the evidence of hypertensive arterial change in hindlimb unloading rats. METHODS: A total of 16 Sprague-Dawley rats were divided into the 2 and the 4 weeks hindlimb unloading groups and their control groups, respectively. After experimental exposure, the carotid artery, the thoracic/abdominal aorta, and the femoral artery were obtained from each experimental and control groups. The degree of matrix metalloproteinase (MMP)-2, MMP-9, and tissue inhibitor of MMPs type 1 (TIMP-1) expression were analyzed by immunohistochemical stain. RESULTS: The increase of MMP-2, 9 expression was noted in the carotid artery and the thoracic aorta from the 4 weeks hindlimb unloading group. On the other hand, the MMP-2, 9 expression was negligible in the abdominal aorta and the femoral artery of this group. In general, the findings of the 2 weeks hindlimb unloading group were similar to those of the control group. The TIMP expression was not found in all groups. CONCLUSION: We found the evidence of hypertensive arterial change by increased shear stress on upper body part's arteries in simulated microgravity. Considering the possible development of this change into hypertensive arterial damage with other cardiovascular risk factors, our findings can be highlighted as an important medical concern, especially in a long-term spaceflight.
Animals ; Aorta ; Aorta, Abdominal ; Aorta, Thoracic ; Arteries ; Carotid Arteries ; Femoral Artery ; Hand ; Hindlimb Suspension* ; Hindlimb* ; Matrix Metalloproteinases ; Monocytes ; Rats* ; Rats, Sprague-Dawley ; Risk Factors ; Space Flight ; Weightlessness

We report our experience using Onyx for embolization of dural arteriovenous fistula (DAVF) under dual lumen balloon catheter flow arrest. Transfemoral cerebral angiography revealed a superior sagittal sinus (SSS) DAVF that was supplied via multiple branches of the external carotid arteries, the right anterior cerebral arteries, and the meningeal branches of the internal carotid artery. There was no anterograde venous drainage through the SSS, and venous drainage was almost retrograde through the medullary and cortical veins. Under general anesthesia, a transvenous approach was utilized to place the microcatheter close to the fistula site. After intravenous embolization with various coils, DAVF was partially occluded; Balloon catheter gained access to the DAVF via the right middle meningeal artery. We injected Onyx through the Scepter C catheter, after which DAVF was nearly completely occluded. Balloon-assisted Onyx embolization is a feasible and effective approach for the management of DAVF.
Anesthesia, General ; Anterior Cerebral Artery ; Carotid Artery, External ; Carotid Artery, Internal ; Catheters ; Central Nervous System Vascular Malformations ; Cerebral Angiography ; Drainage ; Fistula ; Hypogonadism ; Meningeal Arteries ; Mitochondrial Diseases ; Ophthalmoplegia ; Superior Sagittal Sinus ; Veins

Two cases of massive epistaxis following nonpenetrating head injury are reported. A 23-year-old man was referred to us because of massive epistaxis and binocular blindness which developed about two months after a head injury. Carotid angiography demonstrated a intracavernous carotid aneurysm protruding into the ethmoid and sphenoid sinuses, and occlusion of the supraclinoid part of contralateral carotid artery. CT scan demonstrated a large hyperdense mass extending into the parasellar area, the ethmoid and sphenoid sinuses, and both orbits with destruction of bony structures. Treatment was delayed because the patient developed typhoid fever and sepsis, he died about six months after a head injury from a severe cerebral infarction due to internal carotid artery occlusion. A 34-year-old man, involved in a car accident, was admitted in semicomatose state. Over the next 72 hr he become more alert but he had massive epistaxis 11 day later which required blood transfusions. Carotid angiography revealed a false aneurysm of the distal part of the internal maxillary artery. About 30 days later, the false aneurysm occluded by embolization with Gelfoam. The patient recovered uneventfully from these procedures.
Adult ; Aneurysm ; Aneurysm, False ; Angiography ; Blindness ; Blood Transfusion ; Carotid Arteries* ; Carotid Artery Injuries* ; Carotid Artery, External ; Carotid Artery, Internal ; Cerebral Infarction ; Craniocerebral Trauma* ; Epistaxis* ; Gelatin Sponge, Absorbable ; Head Injuries, Closed ; Head* ; Humans ; Maxillary Artery ; Orbit ; Sepsis ; Sphenoid Sinus ; Telescopes ; Tomography, X-Ray Computed ; Typhoid Fever ; Young Adult

It was reported that use of aprotinin in elderly patients undergoing hypothermic circulatory arrest was associated with an increased risk of renal dysfunction, and myocardial infarction as a result of intravascular coagulation. We reviewed 20 patients who received high-dose aprotinin under deep hypothermic circulatory arrest with(NP group, n=11) or without selective cerebral perfusion(SP group, n=9). The activated clotting time was exceeded 750 seconds in all but 1 patient. After opening aortic arch, retrograde low flow perfusion was maintained through femoral artery to prevent air embolization to the visceral arteries. Four patients among 20 died during hospitalization due to bleeding, coronary artery dissection, pulmonary hemorrhage and multiple cerebral infarction. Postoperatively, cerebrovascular accidents occurred in two patients; one with preoperative carotid artery dissection and the other with unknown multiple cerebral infarction. In conclusion, use of aprotinin in young patients undergoing hypothermic circulatory arrest did not increase the risk of renal dysfunction or intravascular coagulation if ACT during circulatory arrest is maintained to exceed 750 seconds with low-flow perfusion.
Acute Kidney Injury ; Aged ; Aorta, Thoracic ; Aprotinin* ; Arteries ; Carotid Arteries ; Cerebral Infarction ; Circulatory Arrest, Deep Hypothermia Induced ; Coronary Vessels ; Femoral Artery ; Hemorrhage ; Hospitalization ; Humans ; Myocardial Infarction ; Perfusion ; Stroke

BACKGROUND: Behcet's disease (BD) is a systemic disease of unknown cause, belonging to vasculitis pathologically. There are only few reports describing the frequency and clinical features of cardiovascular involvement in BD, even though the vascular lesions involving artery and large-sized vein has been reported to be important in prognosis. We performed a retrospective study to address the clinical features of Behcet's disease involving cardiovascular system. METHODS: We studied 155 patients with BD who fulfilled the international criteria. The frequency and clinical characteristics of cardiovascular involvement were studied retrospectively. RESULTS: Among 155 patients with BD, 27 patients (17.4%) have cardiovascular involvement. When they were compared with patients without cardiovascular lesions, male proportion was significantly higher (OR 5.541, 95% CI 2.033~15.105, p=0.001) and the age at onset was younger (OR 1.059, 95% CI 1.003~1.118, p=0.037). Nine patients (5.8%) had arterial lesions which included 10 cases of arterial aneurysm and 3 cases of arterial occlusion. Arterial aneurysm occurred at aorta (3 cases) and pulmonary artery (3 cases) most frequently. Arterial occlusion occurred at coronary artery, brachial artery and digital artery. There were 4 patients with cardiac valvular lesions which included aortic regurgitation (3 cases) and tricuspid stenosis (1 case). Nineteen patients (12.3%) had venous lesions. Among them deep vein thrombosis were 25 cases, and transverse sinus thrombosis was one case. When the patients with deep vein thrombosis were divided by the site of the lesion, the cases involving deep femoral and popliteal vein were the most frequent (6 patients respectively), which were followed by iliac vein, superficial femoral vein, and superior vena cava. When the patients were divided into arterial and venous involvement groups, they showed no significant differences in clinical features. CONCLUSION: In BD patients, the frequency of cardiovascular involvement was 17.4% of which that of deep vein thrombosis was the highest. Arterial aneurysm was the most frequent among arterial lesions. The patients with cardiovascular involvement had significantly higher male proportion and younger onset age than the patients without cardiovascular lesions.
Age of Onset ; Aneurysm ; Aorta ; Aortic Valve Insufficiency ; Arteries ; Brachial Artery ; Cardiovascular System ; Constriction, Pathologic ; Coronary Vessels ; Femoral Vein ; Humans ; Iliac Vein ; Lateral Sinus Thrombosis ; Male ; Popliteal Vein ; Prognosis ; Pulmonary Artery ; Retrospective Studies ; Vasculitis ; Veins ; Vena Cava, Superior ; Venous Thrombosis

BACKGROUND: The real incidence of atherosclerotic lesions in carotid and peripheral arteries in coronary artery disease patients is not well known in Korea. The aim of this study was to prospectively evaluate the prevalence of atherosclerotic involvement of the coronary, carotid, and peripheral arteries in each arterial disease patients. This study was also designed to evaluate the risk factors, the clinical characteristics of associated carotid artery stenosis in patients with coronary artery disease, and associated peripheral vascular disease in patients with coronary artery disease. METHODS: Between June 1996 and March 1998, 475 patients (369 males, 106 females, mean age 60+/-10 years) were studied. Three hundred and seventy-three patients who presented with ischemic symptoms were enrolled in the coronary artery disease group, 81 patients were enrolled in the peripheral vascular disease group due to presenting claudications, and 21 patients were enrolled in the carotid stenosis group due to presenting cerebrovascular symptoms. Coronary angiography was done by the routine method. Carotid angiography was performed at the aortic arch by the digital subtraction angiography method. Peripheral vascular angiography was taken from the suprarenal abdominal aorta to both femoral arteries. RESULTS: 1) Risk factors for coronary stenosis, peripheral vascular disease, and carotid stenosis: The risk factors were not different between coronary stenosis, peripheral vascular disease, and carotid stenosis groups, but smoking was more frequent among patients with peripheral vascular disease than in patients with coronary stenosis (p-value=0.001). 2) Coronary artery stenosis and carotid artery stenosis: The mean age of coronary artery patients with carotid stenosis was significantly older (p-value=0.006) than for patients without carotid stenosis. The prevalence of peripheral vascular disease was more common in patients with carotid stenosis than in patients without carotid stenosis. 3) Coronary artery stenosis and peripheral vascular disease: Carotid stenosis was more common inpatients with peripheral vascular disease than in patients without peripheral vascular disease in the coronary stenosis group. 4) Prevalence of coronary, carotid, and peripheral artery disease: In patients with coronary stenosis, the prevalence of carotid stenosis was 13.9% and that of peripheral vascular disease was 29.2%. In patients with peripheral artery stenosis, the prevalence of coronary stenosis was 45.7% and that of carotid artery disease was 33.3%. In patients with carotid stenosis, the prevalence of coronary stenosis was 81.0% and that of peripheral vascular disease was 52.4%. CONCLUSION: Carotid artery disease and peripheral vascular disease developed concurrently with coronary artery disease in a significant proportion of patients. Therefore, routine angiography of peripheral and carotid arteries in patients with coronary artery disease is considered, especially in old age.
Angiography* ; Angiography, Digital Subtraction ; Aorta, Abdominal ; Aorta, Thoracic ; Arteries ; Carotid Arteries* ; Carotid Artery Diseases ; Carotid Stenosis ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vessels ; Female ; Femoral Artery ; Humans ; Incidence ; Inpatients ; Korea ; Male ; Peripheral Arterial Disease ; Peripheral Vascular Diseases ; Prevalence ; Prospective Studies ; Risk Factors ; Smoke ; Smoking

Congenital anomalies of the cervical internal carotid artery (ICA) include anomalous origin, hypoplasia or aplasia, and anomalous branches. Among them, congenital anastomosis of the external carotid artery with the cervical ICA is extremely rare. We report herein two patients with congenital external-internal carotid artery anastomoses at the cervical segment with a remnant of the ICA stump or hypoplasia of the ICA.
Carotid Arteries* ; Carotid Artery, External ; Carotid Artery, Internal ; Humans