A 38-year old man was admitted to our hospital due to a 5x6 cm sized pulsating mass in the right neck. He suffered from intermittent neck pain and hoarseness for two months due to the rapidly growing mass. The radiological examinations revealed an aneurysm of the right common carotid artery near the bifurcation, and it was compressing the internal and external carotid arteries. Endarterectomy of the right internal carotid artery, aneurysmectomy of the right common carotid artery and graft interposition were done, while the cerebral circulation was maintained by an internal shunt. Intraoperative injury to the nerve tissue around the aneurysm was avoided. He was discharged on the postoperative 7th day without any complications.
Aneurysm ; Carotid Arteries ; Carotid Artery, Common ; Carotid Artery, External ; Carotid Artery, Internal ; Endarterectomy ; Hoarseness ; Neck ; Neck Pain ; Nerve Tissue ; Transplants

PURPOSE: To evaluate the blood flow patterns and the velocities of the carotid arteries in healthy Korean adults. MATERIALS AND METHODS: We evaluated the blood flow patterns and measured the peak systolic and end-diastolic velocities of the common, internal and external carotid arteries in 48 healthy adults who did not have cardiovascular disorders and neck lesions. The velocity difference was analyzed according to different age groups. In addition, peak systolic and end-diastolic velocity ratio of the internal to common carotid artery was estimated, and our data were compared with values reported by other authors. RESULTS: Generally, the velocity in the younger age group tends be to higher than in older group. The peak systolic and end diastolic velocities of the internal carotid artery were 84.5cm/sec and 30.5cm/sec. The peak systolic and end diastolic velocity ratio of the internal to common carotid artery were 0.715 and 0.966. The internal carotid artery was less resistant in blood flow than the external carotid artery. Our data were lower than the values which were reported by Bluth et al. CONCLUSION: The blood flow velocities of the internal carotid artery in healthy adults were lower than those of previously reported foreign values, but the patterns were similar.
Adult* ; Blood Flow Velocity ; Carotid Arteries* ; Carotid Artery, Common ; Carotid Artery, External ; Carotid Artery, Internal ; Humans ; Neck

PURPOSE: The purpose of this study is to describe the anglographic findings of collateral vessels in cervicofacial vascular lesions with previously ligated carotid arteries and to evaluate the extent of anglographic assessmant needed before embolization. MATERIALS AND METHODS: We retrospectively reviewed 10 cervicofacial vascular lesions with previously ligated carotid artery, which were 6 cases of arteriovenous malformation, 2 cases of carotid cavernous fistula, 1 case of hemangioma and 1 case of arteriovenous realformation with carotid cavernous fistula. The previously ligated arteries are proximal external carotid artery (n=5), branches of external carotid artery (n=2) and common carotid artery (n=3). Common carotid artery or internal carotid artery (n=9), vertebral artery (n=5), ipsilateral external carotid artery (n=4), contralateral external carotid artery (n=5), costocervical trunk (n=2), thyrocervical trunk (n=2) were assessed by conventional angiography. Angiography of both carotid and vertebral arteries was performed in 5 cases. RESULTS: The collateral vascular channels were inferolateral trunk of internal carotid artery (n=8), vertebral artery (n=5), contralateral external carotid artery (n=5), ipsilateral external carotid artery (n=4), deep cervical artery (n=2) and ascending cervical artery (n=l). Embolizations were performed in 9 cases with operative cannulation(n=4), embolization via collateral branches of ipsilateral external carotid artery (n=l), embolization via collateral branches of contralateral external carotid artery (n=3) and balloon occulusion via direct puncture (n=l). CONCLUSION: The collateral channels in cervicofacial vascular lesions with previouly ligated carotid artery were inferolateral trunk of internal carotid artery, contralateral or ipsilateral external carotid artery, vertebral artery, deep cervical artery and ascending cervical artery on angiography. Complete anglographic assessment of possible collateral channels is mandatory for the effective and safe embolization.
Angiography ; Arteries ; Arteriovenous Malformations ; Carotid Arteries* ; Carotid Artery, Common ; Carotid Artery, External ; Carotid Artery, Internal ; Fistula ; Hemangioma ; Punctures ; Retrospective Studies ; Vertebral Artery

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

PURPOSE: Various duplex criteria have been used to predict hemodynamically significant carotid artery stenosis. Clinicians have relied on published institutional experience for carotid duplex ultrasound interpretation. Duplex parameters for interpreting carotid artery stenosis severity consist of peak systolic velocity (PSV) and end-diastolic velocity of the internal carotid artery (ICA), the ratio of ICA PSV and end-diastolic velocity (EDV) to common carotid artery (CCA) PSV (PSVICA/CCA) and EDV (EDVICA/CCA). This study was performed to elucidate which duplex parameter can predict the severity of the carotid artery stenosis more accurately. METHODS: The carotid duplex ultrasound and angiographic results of 121 carotid arteries were analyzed. Receiver operater characteristic (ROC) curves were used to compare PSV, EDV, and both ratios in detecting > or =50%, > or =60%, and > or =70% stenosis of the internal carotid artery. RESULTS: The PSVICA/CCA ratio can accurately detect > or =50%, > or =60%, and > or =70% stenosis of the internal carotid artery. To detect > or =50% angiographic stenosis, a PSVICA/CCA ratio of 1.2 has a sensitivity of 83% and specificity of 77%. A PSVICA/CCA ratio of 1.8 can detect > or =60% angiographic stenosis with a sensitivity of 80% and specificity of 79%. Finally, a PSVICA/CCA ratio of 2.2 can detect > or =70% angiographic stenosis with a sensitivity and specificity of 70 and 89%, respectively. CONCLUSION: The PSVICA/CCA ratio can be used for detecting internal carotid artery angiographic stenosis. PSVICA/CCA ratios of 1.2, 1.8, and 2.2 are proper criteria for interpreting 50%< or =, 60%< or = and 70%< or = stenosis, respectively.
Carotid Arteries ; Carotid Artery, Common ; Carotid Artery, Internal ; Carotid Stenosis ; Constriction, Pathologic ; Sensitivity and Specificity

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

Carotid cavernous sinus fistula is abnormal communication between the carotid artery and the cavernous sinus. It can be classified according to three criteria : 1) pathologically into spontaneous or traumatic ; 2) hemodynamically into high flow or low flow fistula ; 3) angiographically into direct or dural fistula. We studied the regional cerebral blood flow changes in traumatic carotid cavernous sinus fistula. Regional cerebral blood flow checked 7 times during trapping procedure. The results are as follows ; 1) regional cerebral blood flow decreased in normal side than in lesion side hemisphere in the state of carotid cavernous fistula. 2) After compression of lesion side common carotid artery over 10 minutes, cerebral blood flow increased in both side. 3) Cerebral blood flow decreased temporary after operation on both side but normalized 2 or 3 weeks later.
Carotid Arteries ; Carotid Artery, Common ; Carotid-Cavernous Sinus Fistula ; Cavernous Sinus ; Fistula*

The description of the carotid artery and venous structure in the cavernous sinus, because of their size and location, was very short or even absent in the most anatomical textbooks. But, since the report of a direct surgical approach to the cavernous sinus by Parkinson in 1965, there has been an increasing number of reports of successful direct surgical approaches to the cavernous sinus. With the introduction of microsurgery and the developement of new techinques and surgical approach, a more accurate knowledge of vascular anatomy of the cavernous sinus is not only of theoretical academic interest, but may also have implications. To better study this vascular anatomy, eighty cavernous sinuses from fresh cadavers of adult subjects were dissected under the operating surgical microscope. A red solution of resin was injected to facilitate the dissection, and twenty cavernous sinuses were studied, based on serial sections in the coronal planes for the study of the venous structure of the cavernous sinus. The results of this study were summarized as follows. 1) The most common branch of internal carotid artery in the cavernous sinus was the meningohypophyseal trunk, the largest intracavernous branch, which was presented in 100% of our specimens, the inferior cavernous artery, in 96.3%, and capsular artery, in 13.8%. 2) The ophthalmic artery arised within the paraclinoid portion of the internal carotid artery in 33.8%. In 3.8%, it entered the floor of the optic canal through a foramen in the bone. But there was no intracavernous origin of the ophthalmic artery. 3) The cavernous sinus seemed to be a venous pathway, an irregualr network of venous channel, not a trabeculated sinus.
Adult ; Arteries ; Cadaver ; Carotid Arteries* ; Carotid Artery, Internal ; Cavernous Sinus ; Humans ; Microsurgery ; Ophthalmic Artery

PURPOSE: Sometimes, intracranial pathology in the distal vasculature cannot be accessed by standard endovascular techniques because of occlusion or insurmountable tortuosity of theinternal carotid artery (ICA). A trans-sphenoidal surgical approach can follow a similar trajectory to the course of the supraclinoid ICA. This study evaluates the feasibility of a trans-sphenoidal approach to the supraclinoid ICA for endovascular access. MATERIALS AND METHODS: In a fresh cadaver head, the sphenoid sinus was dissected through a trans-sphenoidal route. Bone over the carotid prominence was removed to expose the ICA. The artery was catheterized using the Seldinger technique, and three-dimensional digital subtraction angiography was performed to evaluate the procedure. RESULTS: The catheter was successfully inserted into the supraclinoid ICA via the trans-sphenoidal route. Three-dimensional radiographic reconstruction confirmed placement of the catheter and the trajectory of the sheath into the supraclinoid ICA. CONCLUSION: While the trans-sphenoidal route has innumerable disadvantages over the standard endovascular access techniques, this route could be considered when other treatment options are too risky or impractical.
Angiography, Digital Subtraction ; Arteries ; Cadaver ; Carotid Arteries ; Carotid Artery, Internal ; Catheters ; Endovascular Procedures ; Head ; Sphenoid Sinus

PURPOSE: Atherosclerotic risk factors are highly associated with the progression and severity of cerebrovascular disease; the carotid artery intima-media thickness (IMT) correlates well with the known risk factors for atherosclerosis. The aims of this study are to evaluate the associations of the carotid artery IMT with the atherosclerotic risk factors and to determine the reference values of the carotid artery IMT in healthy subjects who were without cardiovascular symptoms. METHOD: Ultrasound high-resolution B-mode imaging of the carotid artery was performed in 273 subjects (168 men, 105 women). We investigated the mean carotid artery IMT and the correlation between the carotid artery IMT and the atherosclerotic risk factors. RESULT: The mean carotid artery IMT values were 0.70+/-0.25 mm in the common carotid artery, 0.61+/-0.15 mm in the internal carotid artery, 0.55+/-0.26 mm in the external carotid artery and 0.92+/-0.45 mm in the carotid bulb. The mean carotid artery IMT was significantly increased with increasing age (P<0.05), and particularly in males. Age, systolic and diastolic blood pressure, body mass index, total cholesterol and LDL cholesterol levels correlated with the mean carotid artery IMT. Especially, the presence of plaque (26 subjects) was correlated with the mean carotid artery IMT in the internal carotid artery (P<0.05) and bulb (P<0.01). CONCLUSION: This study revealed the correlation between the carotid artery IMT and the atherosclerotic risk factors; we also elucidated the reference values for the mean carotid artery IMT in healthy subjects who were without cardiovascular diseases and symptoms.
Atherosclerosis ; Blood Pressure ; Body Mass Index ; Cardiovascular Diseases ; Carotid Arteries* ; Carotid Artery, Common ; Carotid Artery, External ; Carotid Artery, Internal ; Cholesterol ; Cholesterol, LDL ; Humans ; Male ; Reference Values ; Risk Factors* ; Ultrasonography