The Change in Distance Between Bilateral Internal Carotid Arteries in Acromegaly and Its Risk Factors

Abstract

Background: Studies investigating the change in distance between the bilateral internal carotid arteries (ICAs) in acromegalic patients have provided ambiguous results. The influencing factors of these changes have not been well-identified. Objective: To further investigate the change in distance between bilateral ICAs in acromegaly patients and identify the influencing factors of the change. Method: Patients diagnosed as acromegaly from Jan 2016 to Sep 2019 in the Department of Neurosurgery of the First Affiliated Hospital of Fujian Medical University, were included in this study. Computed tomography angiography (CTA) or magnetic resonance angiography (MRA) data were obtained for all patients for three-dimensional reconstruction of the ICAs. Distance between bilateral ICAs was measured and recorded for assessment. Result: 172 patients including 86 cases with acromegaly in the study group and 86 cases with non-functional pituitary adenoma in the control group were enrolled in this study. The difference of adenoma sizes between two groups was not statistically significant. Patients in acromegaly group had significantly larger maximum distances between bilateral siphon carotid ectasias (25.5 ± 4.1 vs. 23.4 ± 3.5 mm, P = 0.001) and between bilateral lacerum segments (26.2 ± 3.2 vs. 24.1 ± 4.3 mm, P < 0.001) compared with those of patients with non-functional pituitary adenomas. Multivariate analysis showed that the increased bilateral ICAs distance was associated with disease duration (odds ratio = 1.01, 95% confidence interval = 1.01–1.02, P = 0.005) and refractory pituitary adenoma (odds ratio = 9.8, 95% confidence interval = 1.1–88.7, P = 0.043) but not with level of growth hormone (GH), insulin-like growth factor-1 (IGF-1) and adenoma size in acromegaly. Conclusion: Our study showed significant change in distance between the bilateral ICAs in acromegalic patients, comparing to patients with non-functional pituitary adenomas. The increased intercarotid artery distance is associated with disease duration but not with preoperative level of GH and IGF-1. Refractory pituitary adenoma and longer disease duration are the both risk factors of the increased ICAs distance in patient with acromegly.

Prediction of the Recurrence of Non-Functioning Pituitary Adenomas Using Preoperative Supra-Intra Sellar Volume and Tumor-Carotid Distance

“…Invasion into the cavernous and/or sphenoid sinus has been proven to be effective in the prediction of recurrence in NFPAs ( 12 ) but quantitative analysis is necessary for precise evaluation. Yan et al., have already used the intercarotid distance for the prediction of total resection of PAs, which is closely related to recurrence ( 13 ). Therefore, we aim to develop a brief and effective evaluation system using intercarotid distance and supra-intrasellar volume for quantifying the horizontal and longitudinal extension of the tumor.…”

Vascular anomalies in patients with growth hormone-secreting pituitary adenomas: illustrative case report and systematic review of the literature

“…The data from this review indicate that Acromegaly's prevalence is likely similar to the general population, given the additional cardiovascular risk factors associated with the disease. A narrowed distance between the internal carotid arteries (i.e., reduced intercarotid distance) was described in six studies [ 29 – 31 , 33 , 34 , 42 ]. Three studies [ 29 , 30 , 32 ] described the appearance of carotid artery protrusion, and two studies [ 29 , 30 ] noticed the loss of bony covering of the carotid artery in the cavernous segment.…”

“…Vascular anomalies of the cerebral arterial circle (Circle of Willis), visualized by CT and MR angiography, were reported in 22 of the included studies [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] (Table 1). The occurrence of aneurysms in patients with elevated GH levels was described in 15 studies [17-28, 35, 36], however, with ten representing single case reports [17,18,[20][21][22][23][24][25][26][27][28].…”

“…On the other hand, numerous studies [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] reported that anatomic vascular anomalies are associated with a higher risk of internal carotid artery injury during surgery. In such cases, life-threatening bleeding can occur, often challenging to manage using the endonasal endoscopic technique.…”

Alterações craniométricas em indivíduos acromegálicos

“…6,[12][13][14] .Apesar das ambiguidades encontradas na literatura, este estudo valida a descrição da redução da distância intercarotídea, reforçando a importância de um planejamento neurocirúrgico específico nas abordagens endoscópicas endonasais nos pacientes acromegálicos.…”