scholarly journals Letter by Goyal and Ospel Regarding Article, “Multiphasic Computed Tomography Angiography Findings for Identifying Pseudo-Occlusion of the Internal Carotid Artery”

Stroke ◽  
2020 ◽  
Vol 51 (11) ◽  
Author(s):  
Mayank Goyal ◽  
Johanna M. Ospel
Keyword(s):  
Computed Tomography ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Computed Tomography Angiography ◽  
Internal Carotid

scholarly journals Multiphasic Computed Tomography Angiography Findings for Identifying Pseudo-Occlusion of the Internal Carotid Artery

Stroke ◽  
2020 ◽  
Vol 51 (8) ◽  
pp. 2558-2562
Author(s):  
Jai Ho Choi ◽  
Jinhee Jang ◽  
Jaseong Koo ◽  
Kook-Jin Ahn ◽  
Yong Sam Shin ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Acute Ischemic Stroke ◽  
Computed Tomography Angiography ◽  
Internal Carotid ◽  
Diagnostic Value ◽  
Fisher Exact Test ◽  
Anterior Circulation

Background and Purpose: Differentiation between pseudo-occlusion and true occlusion of internal carotid artery (ICA) is important in treatment planning for acute ischemic stroke patients. We compared the findings of multiphasic computed tomography angiography between cervical ICA pseudo-occlusion and true occlusion at the cervical ICA in patients with anterior circulation acute ischemic stroke to determine their diagnostic value. Methods: Thirty patients with nonvisualization of the proximal ICA were included. Diagnosis of pseudo- or true occlusion of the ICA was made based on digital subtraction angiography. Diagnostic performances of multiphasic computed tomography angiography findings—(1) a flame-shaped stump and (2) delayed contrast filling at the cervical ICA— were evaluated and compared. The Fisher exact test, χ 2 test, or Wilcoxon rank-sum test and McNemar test were used in the data analysis. Results: Twelve patients had true proximal ICA occlusion and 18 had pseudo-occlusion. Delayed contrast filling at the cervical ICA on multiphasic computed tomography angiography was found in all patients with pseudo-occlusion of the ICA, while 1 case of true occlusion showed delayed contrast filling ( P <0.001). The presence of a flame-shaped stump was not significantly different between the pseudo- and true occlusion groups. The sensitivity of delayed contrast filling (0.94 [95% CI, 0.73–1]) was significantly higher than that of flame-shaped stump (0.75 [95% CI, 0.36–0.83]). Conclusions: We demonstrated that the delayed filling sign on multiphasic computed tomography angiography could be a useful and readily available finding for differentiating proximal ICA pseudo-occlusion from true occlusion.

Carotid Artery Dissection-Related Intracranial Aneurysm Development

Neurosurgery ◽  
2011 ◽  
Vol 70 (2) ◽  
pp. E511-E515 ◽  
Author(s):  
Giuseppe Esposito ◽  
Giovanni Sabatino ◽  
Giorgio Lofrese ◽  
Alessio Albanese
Keyword(s):  
Computed Tomography ◽  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Ct Scan ◽  
Computed Tomography Angiography ◽  
Internal Carotid ◽  
Carotid Artery Dissection ◽  
Artery Dissection ◽  
Neurological Conditions

Abstract BACKGROUND AND IMPORTANCE: We analyzed the physiopathology of the association between cervical artery dissections (CADs), intracranial aneurysms (IAs), and aneurysmal subarachnoid hemorrhage. CLINICAL PRESENTATION: A 43-year-old woman presented with diffuse subarachnoid hemorrhage (Fisher 3; Hunt-Hess 1). computed tomography angiography revealed a cervical internal carotid artery dissection and 2 IAs: right paraclinoid and right posterior communicating artery. The patient underwent surgical clipping of the 2 aneurysms. CAD was managed conservatively. Postoperative course was initially uneventful. After 24 hours, digital subtraction angiography (DSA) documented the exclusion of the aneurysms and an improvement of the CAD. After 3 days, the patient's neurological condition suddenly worsened; CT scan documented a subarachnoid rebleeding (Hunt-Hess 4) and DSA revealed the recurrence of CAD and a new right internal carotid artery aneurysm. The patient underwent clipping of the new aneurysm and decompressive craniectomy because of severe brain swelling. Postoperative neurological conditions remained poor. DSA showed the exclusion of the aneurysms and improvement of CAD. Three days later, CT scan performed after a sudden raise in intracranial pressure documented a wide intracerebral hematoma. Computed tomography angiography did not show new vascular malformations. Surgical removal of the hematoma was performed, but poor neurological conditions persisted. CONCLUSION: CAD-related hemodynamic changes may play a role in the development of IAs. The presence of IAs must be screened carefully in case of CAD, because the dynamic behavior of CAD definitively increases the risk of IA formation, enlargement, and rupture.

scholarly journals Circle of Willis Collateral During Temporary Internal Carotid Artery Occlusion II: Observations From Computed Tomography Angiography

2016 ◽  
Vol 43 (4) ◽  
pp. 538-542 ◽  
Author(s):  
Bill Hao Wang ◽  
Andrew Leung ◽  
Stephen P. Lownie
Keyword(s):  
Computed Tomography ◽  
Mean Arterial Pressure ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Arterial Pressure ◽  
Computed Tomography Angiography ◽  
Collateral Circulation ◽  
Internal Carotid ◽  
Anterior Communicating Artery ◽  
High Grade

AbstractIntroduction: The Circle of Willis (CoW) is the most effective collateral circulation to the brain during internal carotid artery (ICA) occlusion. Carotid stump pressure (CSP) is an established surrogate measure of the cerebral collateral circulation. This study aims to use hemodynamic and computed tomography angiography measurements to determine the strongest influences upon the dependent variable, CSP. These findings could help clinicians noninvasively assess the adequacy of the collateral circulation and facilitate surgical risk assessment in an outpatient setting. Methods: CSP and mean arterial pressure were measured during carotid endarterectomy or during carotid balloon test occlusion in 92 patients. Intracranial arterial diameters were measured on computed tomography angiography at 16 different locations. Univariate and multivariate analyses were used to determine the key factors associated with CSP. In a subgroup of individuals (n=27) with severe (>70% North American Symptomatic Carotid Endarterectomy Trial) contralateral stenosis or occlusion, the same analysis was performed. Results: The contralateral anterior cerebral artery proximal to anterior communicating artery (A1) of the CoW had the strongest influence upon CSP, followed by the mean arterial pressure, the contralateral ICA diameter, and the anterior communicating artery diameter (R2=0.364). In the subgroup with high-grade contralateral ICA stenosis, the ipsilateral posterior communicating artery exerted the strongest influence (R2=0.620). Conclusions: During ICA occlusion, the anterior CoW dominates in preserving collateral flow, especially the contralateral A1 segment. In individuals with high-grade contralateral carotid stenosis, the posterior communicating artery calibre becomes a dominant influence. The most favourable anatomy consists of large contralateral A1 and anterior communicating arteries, and no contralateral carotid stenosis.

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