Twenty-three patients with pulstile bulging on the subclavian (14) and carotid triangles of the neck (9) were investigated with duplex ultrasonography and CT angiography to determine their causes. The causes of pulsatile bulging were innominate tortuosity (14) at right subclavian triangle and prominant carotid sinus (4), common carotid artery tortuosity (2), common carotid artery pseudoaneurysm (1), and carotid artery thrombosis (1) at carotid triangle.
Aneurysm, False ; Angiography ; Carotid Artery Thrombosis ; Carotid Artery, Common ; Carotid Sinus ; Diagnosis ; Humans ; Neck ; Ultrasonography

Alternative to carotid endarterectomy, carotid artery stenting (CAS) can be performed for symptomatic severe stenosis of internal carotid artery, especially for high-risk patients. Among several complications after CAS, subacute in-stent thrombosis is rare but important, because patient's condition can deteriorate rapidly. Subacute in-stent thrombosis with carotid artery occlusion can be managed by superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis. We report two cases of STA-MCA anastomosis for internal carotid artery occlusion by subacute in-stent thrombosis after CAS.
Carotid Arteries ; Carotid Artery, Internal ; Cerebral Arteries ; Constriction, Pathologic ; Endarterectomy, Carotid ; Humans ; Stents ; Thrombosis

A 64-year-old man complaining of pulsatile headache was admitted. Imaging studies revealed a near-total occlusion of the right proximal internal carotid artery (ICA) with slow antegrade flow into the distal ICA. Right cerebral flow was supplied by collateral flow through the posterior communicating and ophthalmic arteries. He was successfully treated by carotid artery stenting. No new neurological deficit or transient ischemic attack occurred after treatment.
Carotid Arteries ; Carotid Artery Thrombosis ; Carotid Artery, Internal ; Headache ; Humans ; Ischemic Attack, Transient ; Middle Aged ; Ophthalmic Artery ; Stents

Preoperative transarterial embolization procedures have been performed in 12 intracranial meningiomas, which were emobolized by superselection technique of the branches of the external carotid artery, using Berenstein superselective catheters or conventional angiographic catheters. PVA(polyvinyl alcohol) and/or Gelfoam particles were used as embolic material. Of the 12 patients, 9 cases were supplied from both internal and external circulation, and 4 of them showed profuse intraoperative bleeding, while 3 cases supplied only from the external circulation could be removed totally with little difficulty in bleeding control. The excised tumor specimens were examined for evidence of thrombosis and infarction, and 6 out of 12 cases showed evident tumor necrosis. Preoperative embolization of the meningioma produced relatively avascular operative conditions in most cases, but in those with dual blood supply, embolization may be of limited value due to an appreciable blood supply from the internal carotid artery.
Carotid Artery, External ; Carotid Artery, Internal ; Catheters ; Gelatin Sponge, Absorbable ; Hemorrhage ; Humans ; Infarction ; Meningioma* ; Necrosis ; Thrombosis

The prognosis of symptomatic bilateral internal carotid artery occlusion is extremely poor. To our knowledge, there are few reports regarding the proper management of this catastrophic event. We present two cases of progressive stroke with acute internal carotid artery occlusion and contralateral chronic carotid occlusion, who were treated by urgent recanalization using stents. In two cases, complete recanalization was achieved and the clinical outcomes were favorable. We suggest that early endovascular treatment using stents may salvage the occluded vessel and may also offer a more successful clinical outcome. Further study will be necessary in order to define the proper management of this catastrophic event.
Arterial Occlusive Diseases ; Carotid Artery Thrombosis ; Carotid Artery, Internal* ; Cerebral Revascularization ; Humans ; Prognosis ; Stents* ; Stroke*

PURPOSE: To evaluate the usefulness of CT angiography in Patients with implantation of metallic stent for stenosed internal carotid artery. MATERIALS AND METHODS: Seven patients with atherosclerotic stenosis of the internal carotid artery underwent metallic stent implantation. All were male and their ages ranged from 36 to 69 years. A total of seven stents were placed in the internal carotid artery in five patients and in the carotid bifurcation in two. Spiral CT scans were obtained and CT angiographic images were reconstructed using MPR or curved MPR techniques at a workstation. The interval between CT and conventional angiography did not exceed six days except in one patient, in whom it was 61days. CT and conventional angiography were compared for stent position with respect to the carotid bifurcation, stent deformation, intraluminal filling defect, and luminal caliber and outflow. Luminal patency of the implanted stent was measured according to NASCET(North American Symptomatic Carotid Endarterectomy Trial) criteria, and statistically processed (p<.05). The presence or absence of intrastent thrombus and vascular wall calcification was determined using axial source images. RESULTS: In all patients, CT angiographic findings matched those obtained by conventional angiography. Complications such as migration or deformation of an implanted stent, intraluminal filling defect, change of luminal caliber or outflow of implanted stent were not observed in any patient. In two studies in which Wilcoxon signed rank test was used, degree of stent expansion correlated closely(p=0.237). Axial source images showed that in no patient was an intrastent thrombus present, though in five, vascular wall calcification of internal carotid arteries outside the stent was noted. CONCLUSION: CT angiography is useful for the assessment of positional change, occlusion, and luminal patency of a stent-implanted internal carotid artery.
Angiography ; Carotid Artery, Internal* ; Constriction, Pathologic ; Endarterectomy, Carotid ; Humans ; Male ; Phenobarbital ; Stents* ; Thrombosis ; Tomography, Spiral Computed

Acute occlusion of the intracranial internal carotid artery (ICA) bifurcation, so-called "carotid T occlusion," extends from distal portion of the internal carotid into the proximal segments of the middle and anterior cerebral arteries. This carotid T occlusion has been associated with low recanalization rates and poor prognosis. An 83-year-old man underwent successful transarterial suction thrombectomy using manual compression of ipsilateral common carotid artery for the treatment of acute carotid T-occlusion. Herein, we report this case and discuss the technical aspect.
Aged, 80 and over ; Anterior Cerebral Artery ; Arterial Occlusive Diseases ; Carotid Artery Thrombosis ; Carotid Artery, Common* ; Carotid Artery, Internal ; Humans ; Prognosis ; Suction ; Thrombectomy

BACKGROUND: Fucoidan is a highly sulfated glycosaminoglycan, which has a molecular structure similar to that of heparin. The antithrombotic effects of fucoidan in vitro have been widely reported, but its antithrombotic effects in vivo as well as its other biological properties in vitro have not been well investigated. METHODS: This study investigated the effects and mechanism of fucoidan from Fucus vesiculosus on thrombosis both in vitro and in vivo. A ferric chloride-induced mouse carotid artery thrombosis model was used to determine the antithrombotic effects of fucoidan in vivo. Additionally, changes in the levels of proinflammatory cytokines and chemokines were examined in vascular cells treated with fucoidan. RESULTS: In vivo studies employing a ferric chloride-induced mouse carotid artery thrombosis model indicated that fucoidan had a stronger antithrombotic activity than heparin. Further, vascular cells treated with fucoidan demonstrated a decrease in proinflammatory cytokine and chemokine production as well as inhibition of proliferation. CONCLUSION: The major findings of this study showed that fucoidan has a stronger antithrombotic effect than heparin in vivo and that fucoidan has an inhibitory effect on proinflammatory cytokine production and proliferation of vascular cells.
Animals ; Carotid Artery Thrombosis ; Chemokines ; Cytokines ; Fucus ; Glycosaminoglycans ; Heparin ; Mice ; Molecular Structure ; Polysaccharides ; Thrombosis

Fatal traumatic thrombosis of the right internal carotid artery occurred in a 37-year-old woman following minor blunt cervical trauma (grasped her neck) during an altercation. An external examination revealed only linear abrasion of right side of neck. The autopsy revealed a thrombosis in the right internal carotid artery and thromboembolism in right middle cerebral arteries. The gross and microscopic findings of the internal carotid artery are presented and the significance of minor cervical blunt trauma and the possible mechanism for the vascular lesion are discussed.
Adult ; Autopsy ; Carotid Artery, Internal* ; Female ; Humans ; Middle Cerebral Artery ; Neck Injuries ; Neck* ; Thromboembolism ; Thrombosis*

In patients with acute ischemic stroke, carotid duplex ultrasonography has been used to assess atherosclerotic lesions at the extracranial carotid artery. We reported a unique sonographic finding of carotid artery thrombus in a patient with acute cardioembolic stroke and atrial fibrillation. An 81-year-old woman with atrial fibrillation was presented with dysarthria and left side hemiparesis. She had undergone surgical thrombectomy and angioplasty for her right brachial artery occlusion four days before the stroke onset. Diffusion-weighted MRI revealed multiple territorial infarctions suggestive of acute cardio-embolic stroke. CT angiography showed an occlusion of the right common carotid artery. On B-mode ultrasonography, longitudinal intraluminal tortuous cylinderic oscillating thrombus was observed on the right distal common carotid artery to the proximal internal carotid artery. This case illustrates a unique ultrasonographic finding of acute cardiogenic thrombus in the extracranial carotid artery.
Angiography ; Angioplasty ; Atrial Fibrillation ; Brachial Artery ; Carotid Arteries ; Carotid Artery, Common ; Carotid Artery, Internal ; Cerebral Infarction ; Dysarthria ; Female ; Humans ; Infarction ; Paresis ; Stroke ; Thrombectomy ; Thrombosis