Symmetry, asymmetry and hypoplasia of the intracranial internal carotid artery on magnetic resonance angiography

Mujagić, Svjetlana; Kozić, Duško; Huseinagić, Haris; Smajlović, Dževdet

doi:10.5644/ama2006-124.150

Cited by 12 publications

(14 citation statements)

References 16 publications

(23 reference statements)

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“…The present study used 3D-DSA to obtain the range, 95% confidence interval, and mean values for the inner diameters of the proximal CS, CS bulge, distal CS, and CCA. The values obtained in this analysis (see Table 2) were generally smaller than those reported by previous studies using CTA [22,23], ultrasonography [24][25][26][27], and MRA [28]. There are several possible reasons for the apparent discrepancy between our findings and those of previous investigations.…”

Section: Discussioncontrasting

confidence: 99%

“…Fourth, the sample sizes of many of the above studies were small, which increases the likelihood of sampling errors. We found that the inner diameters of the bilateral CS and distal CCA were greater in males than females, consistent with observations reported by several prior investigations using CTA, ultrasonography, or MRA [22,24,[26][27][28][29]. One possible reason for the larger vessel diameters in males than females is that men have, on average, a larger body size.…”

Section: Discussionsupporting

confidence: 91%

“…An interesting observation of this analysis was that the inner diameters of the CS and distal CCA were larger on the right side than on the left side. Several published studies have also reported a larger luminal diameter for the right CCA than for the left CCA [24,27], although not all authors agree [22,28,29]. In view of the clear variation between left and right sides in this study, which included a large number of participants and used a technique with a high spatial resolution (3D-DSA), the failure of some other studies to detect such differences may be related to smaller sample size (which would reduce the power of the analysis) and use of methods with poorer spatial resolution.…”

Section: Discussionmentioning

confidence: 99%

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Inner diameters of the normal carotid arteries measured using three-dimensional digital subtraction catheter angiography: a retrospective analysis

et al. 2021

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Purpose To obtain normal ranges for the inner diameters of the carotid arteries. Methods This retrospective analysis included consecutive patients with disease-free carotid arteries who had undergone 3D-DSA at two hospitals in Nanning, Guangxi, between March 2013 and March 2018. Demographic and clinical characteristics, including Essen Stroke Risk Score (ESRS), were extracted from the medical records. The 3D-DSA data were used to calculate the inner diameters of the carotid arteries. Results The analysis included 1182 patients (837 males) aged 58.81 ± 11.02 years. The inner diameters of the proximal carotid sinus (CS), CS bulge, distal CS, and common carotid artery (CCA) were larger on the right than on the left (P < 0.05). The inner diameters of the proximal CS, CS bulge, distal CS, and CCA on both sides were larger for males than females (P < 0.05). The inner diameters of the proximal CS, CS bulge, and distal CS on both sides were smaller for patients aged > 65 years than for patients aged ≤ 55 years (P < 0.05). Right CCA inner diameter did not vary with age, whereas left CCA inner diameter was larger for patients aged > 55 years than for patients aged ≤ 45 years (P < 0.05). The inner diameters of the proximal CS, CS bulge, and distal CS on both sides were smaller for patients with ESRS ≥ 3 than those with ESRS < 3 (P < 0.05). Conclusion This study provides reference values for the internal diameters of normal carotid arteries. Carotid artery diameters varied with side, sex, and age.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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Inner diameters of the normal carotid arteries measured using three-dimensional digital subtraction catheter angiography: a retrospective analysis

et al. 2021

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“…This represented a total of 37 cases of CICAH. The remaining articles included seven cohort studies, [9][10][11][12][13][14][15] one letter 16 and one review. 17 The mean age at diagnosis was 41.4 years.…”

Section: Search Resultsmentioning

confidence: 99%

Congenital internal carotid artery hypoplasia: A systematic review

et al. 2022

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This review evaluates the current evidence for the clinical management of congenital internal carotid artery hypoplasia (CICAH). We summarise clinical presentations diagnostic standards, imaging recommendations, treatment and follow-up. The review was prompted by a case of CICAH in a 50-year-old female who presented to our neurosurgery clinic with an acute episode of vertigo. The patient underwent CT angiogram, which showed an unusually low right carotid bifurcation. The right internal carotid artery (ICA) was hypoplastic, and the A1 segment of the anterior cerebral artery (ACA) was absent. Skull base CT showed an ipsilateral hypoplastic carotid canal. To summarise current evidence for clinical management of CICAH we followed PRISMA guidelines to identify papers meeting our predefined inclusion criteria. We searched three databases using the terms ‘ICA’ and ‘Hypoplasia’. We reviewed 41 papers meeting our criteria. 34 were clinical reports. We performed a data extraction and quality appraisal on these reports. We found that CICAH may be less rare than previously described. Blood pressure control in CICAH is crucial due to the increased risk of stroke and aneurysm formation. Follow-up imaging is strongly recommended. Carotid doppler sonography is a powerful and underutilised diagnostic tool, and carotid canal hypoplasia is not a pathognomic sign. In conclusion, clinicians should be alert to anatomic variations such as CICAH because these produce haemodynamic changes that may have serious clinical consequences. We recommend a central registry of patients with CICAH in order to understand the longer-term natural history of the condition.

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“…The morphology of the petrous ICA is variable between individuals, and can be asymmetric, which in addition to an inconsistent degree of elasticity in the nares of preserved heads could potentially explain a higher variability of surgical freedom observed with the endonasal techniques (standard deviation greater than the mean). This variability could play to the advantage of the endonasal corridor and be sufficient in most cases, reinforcing the role of a transpalatal corridor as secondary to an already completed transpterygoid infrapetrous EEA.…”

Section: Discussionmentioning

confidence: 99%

Modified endoscopic endonasal approach with a minimally invasive transoral approach—an adjunct to infrapetrous approaches

et al. 2018

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Objectives/Hypothesis To evaluate the potential of a minimally invasive transoral–transpalatal approach (MITA) to the retrocarotid petrous apex, as an adjunct to endoscopic endonasal approaches (EEAs). Study Design Cadaver study. Methods Five cadaveric specimens were dissected raising an inverted U‐shaped palatal mucoperiosteal flap, and drilling a rectangular palatotomy (between the greater palatine foramens, and just anterior to the palatine aponeurosis). This allowed a transpterygoid EEA with cross‐court access (contralateral line of sight), followed by an extradural clivectomy that exposed the petroclival junction bilaterally. Surgical targets were marked on the posterior and medial surface of the petrous internal carotid artery (ICA), at its anterior genu, midhorizontal portion, and posterior genu. For each target and approach, the surgical freedom and angles of approach (in the horizontal and vertical planes) were calculated and statistically compared. Results Compared to EEA, the MITA resulted in greater surgical freedom for all targets, with the highest values at the anterior genu (1,661.37 mm2 vs. 312.76 mm2, P <.001), and maintaining superiority in this regard all the way to the posterior genu (847.84 mm3 vs. 138.91 mm3, P < .005). MITA also offered greater angles of approach for all targets. Conclusions This study suggests that the MITA may be indicated to supplement the exposure provided by a transpterygoid EEA. This technique, associated with low potential morbidity, offers an alternative to internal carotid lateralization while managing extradural lesions that are adjacent to the petrous ICA. Level of Evidence NA Laryngoscope, 129:339–343, 2019

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Symmetry, asymmetry and hypoplasia of the intracranial internal carotid artery on magnetic resonance angiography

Abstract: Congenital hypoplasia of ICAs is a very rare abnormality, while asymmetry of ICAs is more common. After evaluating severe asymmetry of intracranial ICAs by MRA, MRA of the neck is recommended, especially in patients with a complete anterior part of the circle of Willis.

Cited by 12 publications

References 16 publications

Inner diameters of the normal carotid arteries measured using three-dimensional digital subtraction catheter angiography: a retrospective analysis

Inner diameters of the normal carotid arteries measured using three-dimensional digital subtraction catheter angiography: a retrospective analysis

Congenital internal carotid artery hypoplasia: A systematic review

Modified endoscopic endonasal approach with a minimally invasive transoral approach—an adjunct to infrapetrous approaches

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