Implicating the long styloid process in cervical carotid artery dissection

Muthusami, Prakash; Kesavadas, Chandrasekharan; Sylaja, PN; Harsha, Kamble Jayaprakash; Kapilamoorthy, Tirur Raman

doi:10.1007/s00234-013-1186-1

Cited by 25 publications

(14 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…8 Because intramural hematoma may distort ICA anatomy and change its position in relation to other fixed cervical structures, we believe that measurement of the distance between SP and the center of the structure formed by the hematoma and the arterial lumen describes a more reliable anatomical relation between these structures, even though it does not completely exclude the bias introduced by large position changes, such as those caused by pseudoaneurysms. Muthusami et al 9 also found a marginal association of longer SP length and shorter SP-ICA distance in ICAD patients when compared to controls; however, this study was conducted in a single center, included fewer cases, and used a different method to measure SP-ICA distance. 9 In contrast to the first two studies, 6,8 we found that the characteristics of the SP contralateral to ICAD were not significantly associated with dissection, which could explain the low frequency of bilateral ICAD.…”

Section: Discussionmentioning

confidence: 86%

“…Muthusami et al 9 also found a marginal association of longer SP length and shorter SP-ICA distance in ICAD patients when compared to controls; however, this study was conducted in a single center, included fewer cases, and used a different method to measure SP-ICA distance. 9 In contrast to the first two studies, 6,8 we found that the characteristics of the SP contralateral to ICAD were not significantly associated with dissection, which could explain the low frequency of bilateral ICAD. However, this association was only marginally nonsignificant, which could be related to the sample size.…”

Section: Discussionmentioning

confidence: 86%

See 1 more Smart Citation

Anatomical characteristics of the styloid process in internal carotid artery dissection: Case–control study

Amorim

Pereira

Rodrigues

et al. 2017

International Journal of Stroke

View full text Add to dashboard Cite

Introduction Pathophysiology of cervical artery dissection is complex and poorly understood. In addition to well-known causative and predisposing factors, including major trauma and monogenic connective tissue disorders, morphological characteristics of the styloid process have been recently recognized as a possible risk factor for cervical internal carotid artery dissection. Aims To study the association of the anatomical characteristics of styloid process with internal carotid artery dissection. Methods Retrospective, multicenter, case-control study of patients with internal carotid artery dissection and age- and sex-matched controls. Consecutive patients with internal carotid artery dissection and controls with ischemic stroke or transient ischemic attack of any etiology excluding internal carotid artery dissection, who had performed computed tomography angiography, diagnosed between January 2010 and September 2016. Two independent observers measured styloid process length and styloid process distance to internal carotid artery. Results Sixty-two patients with internal carotid artery dissection and 70 controls were included. Interobserver agreement was good for styloid process length and styloid process-internal carotid artery distance (interclass correlation coefficient = 0.89 and 0.76, respectively). Styloid process ipsilateral to dissection was longer than left and right styloid process in controls (35.8 ± 14.4 mm versus 30.4 ± 8.9 mm and 30.3 ± 8.2 mm, p = 0.011 and p = 0.008, respectively). Styloid process-internal carotid artery distance ipsilateral to dissection was shorter than left and right distance in controls (6.3 ± 1.9 mm versus 7.2 ± 2.1 mm and 7.0 ± 2.3 mm, p = 0.003 and p = 0.026, respectively). Internal carotid artery dissection was associated with styloid process length (odds ratio = 1.04 mm, 95% confidence interval = 1.01-1.08, p = 0.015) and styloid process-internal carotid artery distance (OR = 0.77 mm, 95% confidence interval = 0.64-0.92, p = 0.004). Conclusion Longer styloid process and shorter distance between styloid process and cervical internal carotid artery are associated with cervical internal carotid artery dissection.

show abstract

Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 86%

Anatomical characteristics of the styloid process in internal carotid artery dissection: Case–control study

Amorim

Pereira

Rodrigues

et al. 2017

International Journal of Stroke

View full text Add to dashboard Cite

show abstract

“…8–10) Direct mechanical contact was more common in patients with CAD than control subjects. 9) These studies imply longer styloid process and shorter stylo-ICA distance are the important risk factors causing CAD.…”

Section: Discussionmentioning

confidence: 99%

Carotid Artery Dissection Caused by an Elongated Styloid Process: Three Case Reports and Review of the Literature

Ogura

Mineharu

Todo

et al. 2015

NMC Case Report Journal

View full text Add to dashboard Cite

Eagle syndrome is a set of symptoms associated with an elongated styloid process. Although it is an important cause of cerebrovascular complications such as carotid artery dissection (CAD) or thromboembolism, the condition may be underdiagnosed. We treated three patients with CAD caused by an elongated styloid process within a year. The first patient was a 55-year-old man who developed recurrent thromboembolism despite anticoagulation therapy. Computed tomography (CT) angiography showed bilateral CAD with tips of styloid processes attached to the dissected lesions. He underwent surgical resection of the styloid process followed by carotid artery stenting. The second patient was also a 55-year-old man who developed acute stroke due to carotid artery occlusion, and underwent thrombectomy and carotid artery stenting. Both these patients experienced resolution of their neurological symptoms and had no recurrence of stroke. The third patient was an 80-year-old man with an asymptomatic dissecting aneurysm of the cervical internal carotid artery. He had a history of odynophagia and underwent surgical resection of the styloid process, with resolution of his symptoms. These cases, taken together with recent evidences showing that CAD was associated with the styloid process length, suggest that Eagle syndrome may not be an uncommon cause of CAD. Examination by CT angiography is important to avoid misdiagnosis. A literature review indicates that some cases were refractory to anticoagulation and surgical resection of the elongated styloid process or carotid artery stenting could be a treatment option to prevent further stroke.

show abstract

“…Muthusami et al indicated that, when the distance was ≤5 mm, the odds ratio for the onset of arterial dissection was 7.58. 10) In Cases 1 and 2, initial MRI showed that stenosis of the internal carotid artery was located at a higher position in comparison with arteriosclerotic stenosis; dissection of the internal carotid artery was suspected. In addition, the distance between the lesion and styloid process end was 2-3 mm, suggesting the involvement of the styloid process in dissection of the internal carotid artery.…”

Section: Discussionmentioning

confidence: 94%

Two Patients with Cerebral Infarction Who Underwent Endovascular Treatment for Internal Carotid Artery Dissection Related to an Elongated Styloid Process

Shimozato

Hayashi

Niimura

et al. 2018

JNET

View full text Add to dashboard Cite

Objective:We report two patients with cerebral infarction who underwent endovascular treatment for internal carotid artery dissection related to an elongated styloid process. On arrival, the NIHSS score was 8. MRI showed acute-stage infarction and narrowing of the high-level internal carotid artery adjacent to the left styloid process. Conservative treatment was administered. As there was a dissecting aneurysmal change at the stenotic site, carotid-stent-assisted coil embolization was performed. In the two patients, endovascular treatment led to a favorable prognosis. Conclusion:For the treatment of arteriogenic cerebral infarction related to atypical stenosis of the high-level cervical internal carotid artery, it is important to review therapeutic strategies, considering the possibility of an elongated styloid process.

show abstract

Implicating the long styloid process in cervical carotid artery dissection

Abstract: Length and contact distance of the styloid process are risk factors for CCAD, suggesting mechanical impingement.

Cited by 25 publications

References 13 publications

Anatomical characteristics of the styloid process in internal carotid artery dissection: Case–control study

Anatomical characteristics of the styloid process in internal carotid artery dissection: Case–control study

Carotid Artery Dissection Caused by an Elongated Styloid Process: Three Case Reports and Review of the Literature

Two Patients with Cerebral Infarction Who Underwent Endovascular Treatment for Internal Carotid Artery Dissection Related to an Elongated Styloid Process

Contact Info

Product

Resources

About