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High Suited Carotid Artery Stenosis and Imaging

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Abstract

A stenosis of the internal carotid artery is typically irregular and approximately up to two centimeters distal the bifurcation. However, this is not what it is meant here. The so-called “high suited carotid artery stenoses” are different with respect to imaging procedure, more diagnosis, and particulary in treatment planning, and are a little bit complex than the stenoses just around the bifurcation. It is very important to understand the diagnostic techniques and therapy of traumatic or postsurgery carotid artery dissections and the complex intracranial stenosis. Furthermore, imaging and therapy of atherosclerotic extracranial brachiocephalic stenoses must also be considered. This chapter provides an overview of the various imaging options available, including a specific workflow in case of an emergency (traumatic lesions) and finally a discussion of the clinical, diagnostic and therapeutic knowledge based on the current literature.

Keywords

Carotid Artery Internal Carotid Artery Compute Tomography Angiography Subclavian Artery Carotid Artery Stenosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. [1]
    Akins PT, Pilgram TK, Cross DT 3rd et al.: Natural history of stenosis from intracranial atherosclerosis by serial angiography. Stroke 29: 433–438 (1998).PubMedGoogle Scholar
  2. [2]
    Alazzaz A, Thornton J, Aletich VA et al.: Intracranial percutaneous transluminal angioplasty for arteriosclerotic stenosis. Arch Neurol 57: 1625–1630 (2000).PubMedCrossRefGoogle Scholar
  3. [3]
    Arend WP, Michel BA, Bloch DA et al.: The American College of Rheumatology 1990 criteria for the classification of Takayasu arteritis. Arthritis Rheum 33:1129–1134 (1990).PubMedCrossRefGoogle Scholar
  4. [4]
    Assadian A, Senekowitsch C, Rotter R et al.: Long-term results of covered stent repair of internal carotid artery dissections. J Vasc Surg 40: 484–487 (2004).PubMedCrossRefGoogle Scholar
  5. [5]
    Baumgartner RW, Mattle HP, Schroth G: Assessment of./5 50% and < 50% intracranial stenoses by transcranial color-coded duplex sonography. Stroke 30: 87–92 (1999).PubMedGoogle Scholar
  6. [6]
    Beletsky V, Nadareishvili Z, Lynch J et al.: Canadian Stroke Consortium, Cervical arterial dissection: time for a therapeutic trial? Stroke 34: 2856–2860 (2003).PubMedCrossRefGoogle Scholar
  7. [7]
    Bogousslavsky J, Despland PA, Regli F: Spontaneous carotid dissection with acute stroke. Arch Neurol 44:137–140 (1987).PubMedGoogle Scholar
  8. [8]
    Bogousslavsky J, Barnett HJ, Fox AJ et al.: Atherosclerotic disease of the middle cerebral artery. Stroke 17: 1112–1120 (1986).PubMedGoogle Scholar
  9. [9]
    Brewster DC, Moncure AC, Darling RC et al.: Innominate artery lesions: problems encountered and lessons learned. J Vasc Surg 2: 99–112 (1985).PubMedCrossRefGoogle Scholar
  10. [10]
    CAPRIE Steering Committee: A randomized, blinded, trial of clopidogrel versus aspirin in patients at risk of ischemic events (CAPRIE). Lancet 348: 1329–1339 (1996).CrossRefGoogle Scholar
  11. [11]
    Carotid artery stenting in clinical practice Results from the Carotid Artery Stenting (CAS)-registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausarzte (ALKK). Z Kardiol 94: 163–172 (2005).Google Scholar
  12. [12]
    Cherry KJ Jr, McCullough JL, Hallett JW Jr et al.: Technical principles of direct innominate artery revascularization: a comparison of endarterectomy and bypass grafts. J Vasc Surg 9: 718–724 (1989).PubMedCrossRefGoogle Scholar
  13. [13]
    Chimowitz MI: Angioplasty or stenting is not appropriate as first-line treatment of intracranial stenosis. Arch Neurol 58: 1690–1692 (2001).PubMedCrossRefGoogle Scholar
  14. [14]
    Chimowitz MI, Kokkinos J, Strong J et al.: The Warfarin-Aspirin Symptomatic Intracranial Disease Study. Neurology 45: 1488–1493 (1995).PubMedGoogle Scholar
  15. [15]
    Cohen J, Leker RR, Gotkine M et al.: Emergent stenting to treat patients with carotid artery dissection. Stroke 34: 254–257 (2003).CrossRefGoogle Scholar
  16. [16]
    Comerota AJ, Katz ML, Hosking JD et al.: Is transcranial Doppler a worthwhile addition to screening tests for cerebrovascular disease? J Vasc Surg 21: 90–97 (1995).PubMedCrossRefGoogle Scholar
  17. [17]
    Connors JJ 3rd, Wojak JC: Percutaneous transluminal angioplasty for intracranial atherosclerotic lesions: evolution of technique and short-term results. J Neurosurg 91: 415–423 (1999).PubMedGoogle Scholar
  18. [18]
    Corston RN, Kendall BE, Marshall J: Prognosis in middle cerebral artery stenosis. Stroke 15: 237–241 (1984).PubMedGoogle Scholar
  19. [19]
    Davis SM, Donnan GA.: Advances in Penumbra Imaging with MR. Cerebrovasc Dis [17 Suppl]3: 23–27 (2004).CrossRefGoogle Scholar
  20. [20]
    De Bray JM, Lhoste P, Dubas F et al.: Ultrasonic features of extracranial carotid dissections: 47 cases studied by angiography. J Ultrasound Med 13: 659–664 (1994).PubMedGoogle Scholar
  21. [21]
    de Rochemont Rdu M, Sitzer M, Zanella FE et al.: Stents in the treatment of intracrania atherosclerotic stenoses. Radiologe 44: 1004–1012 (2004).CrossRefGoogle Scholar
  22. [22]
    de Rochemont Rdu M, Turowski B, Buchkremer M et al.: Recurrent symptomatic high-grade intracranial stenoses: safety and efficacy of undersized stents-initial experience. Radiology 231: 45–49 (2004).PubMedGoogle Scholar
  23. [23]
    De Vries JP, Jager LC, Van den Berg JC et al.: Durability of percutaneous transluminal angioplasty for obstructive lesions of proximal subclavian artery: long-term results. J Vasc Surg 41: 19–23 (2005).PubMedCrossRefGoogle Scholar
  24. [24]
    Diener HC, Cunha L, Forbes C et al.: European Stroke Prevention Study. 2. Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke. J Neurol Sci 143: 1–13 (1996).PubMedCrossRefGoogle Scholar
  25. [25]
    Djouhri H, Guillon B, Brunnereau L: MR angiograhy for the long-term follow-up of dissecting aneurysms of the extracranial internal carotid artery. Am J Roentgenol 174: 1137–1140 (2000).Google Scholar
  26. [26]
    Ducrocq X, Lacour JC, Debouverie M et al.: Cerebral ischemic accidents in young subjects. A prospective study of 296 patients aged 16 to 45 years. Rev Neurol 155: 575–582 (1999).PubMedGoogle Scholar
  27. [27]
    Duong TQ, Fisher M: Applications of diffusion/perfusion magnetic resonance imaging in experimental and clinical aspects of stroke. Curr Atheroscler Rep 6:267–273 (2004).PubMedGoogle Scholar
  28. [28]
    English JA, Carell ES, Guidera SA et al.: Angiographic prevalence and clinical predictors of left subclavian stenosis in patients undergoing diagnostic cardiac catheterization. Catheter Cardiovasc Interv 54: 8–11 (2001).PubMedCrossRefGoogle Scholar
  29. [29]
    Fanelli F, Salvatori FM, Ferrari R et al.: Stent repair of bilateral post-traumatic dissections of the internal carotid artery. J Endovasc Ther 11: 517–521 (2004).PubMedCrossRefGoogle Scholar
  30. [30]
    Feldmeier JJ, Merendaz C, Regli F: Symptomatic stenosis of the middle cerebral artery. Rev Neurol 139:725–736 (1983).Google Scholar
  31. [31]
    Ferrara F, Meli F, Raimondi F et al.: Subclavian stenosis/occlusion in patients with subclavian steal and previous bypass of internal mammary interventricular anterior artery: medical or surgical treatment? Ann Vasc Surg 18: 566–571 (2004).PubMedCrossRefGoogle Scholar
  32. [32]
    Gelal FM, Kitis O, Calli C et al.: Craniocervical artery dissection: diagnosis and follow-up with imaging and MR angiography. Med Sci Monit 10: 109–116 (2004).Google Scholar
  33. [33]
    Gomez CR, Misra VK, Liu MW et al.: Elective stenting of symptomatic basilar artery stenosis. Stroke 31:5–9 (2000).Google Scholar
  34. [34]
    Gomez CR, Misra VK, Campbell MS et al.: Elective stenting of symptomatic middle cerebral artery stenosis. Am J Neuroradiol 21: 971–973 (2000).PubMedGoogle Scholar
  35. [35]
    Gress DR, Smith WS, Dowd CF et al.: Angioplasty for intracranial symptomatic vertebrobasilar ischemia. Neurosurgery 51: 23–27; discussion 27–29 (2002).PubMedCrossRefGoogle Scholar
  36. [36]
    Gupta R, Schumacher HC, Mangla S et al.: Urgent endovascular revsacularization for symptomatic intracranial atherosclerosis stenosis. Neurology 61: 1729–1735 (2003).PubMedGoogle Scholar
  37. [37]
    Gutierrez GR, Mahrer P, Aharonian V et al.: Prevalence of subclavian artery stenosis in patients with peripheral vascular disease. Angiology 52: 189–194 (2001).PubMedCrossRefGoogle Scholar
  38. [38]
    Hadjipetrou P, Cox S, Piemonte T et al.: Percutaneous revascularization of atherosclerotic obstruction of aortic arch vessels. J Am Coll Cardiol 33: 1238–1245 (1999).PubMedCrossRefGoogle Scholar
  39. [39]
    Hass WK, Easton JD, Adams HP Jr et al.: A randomized trial comparing ticlopidine hydrochloride with aspirin for the prevention of stroke in high-risk patients. Ticlopidine Aspirin Stroke Study Group. N Engl J Med 321: 501–507 (1989).PubMedCrossRefGoogle Scholar
  40. [40]
    Hennerici M, Klemm C, Rautenberg W: The subclavian steal phenomenon: a common vascular disorder with rare neurologic deficits. Neurology 38: 669–673 (1988).PubMedGoogle Scholar
  41. [41]
    Henry M, Amor M, Henry I et al.: Percutaneous transluminal angioplasty of the subclavian arteries. J Endovasc Surg 6: 33–41 (1999).PubMedCrossRefGoogle Scholar
  42. [42]
    Houser OW, Mokri B, Sundt TM Jr et al.: Spontaneous cervical cephalic arterial dissection and its residuum: angiographic spectrum. Am J Neuroradiol 5:27–34 (1984).PubMedGoogle Scholar
  43. [43]
    Huttl K, Nemes B, Simonffy A et al.: Angioplasty of the innominate artery in 89 patients: experience over 19 years. Cardiovasc Intervent Radiol 25: 109–114 (2002).PubMedCrossRefGoogle Scholar
  44. [44]
    Johnson MB, Wilkinson ID, Wattam J et al.: Comparison of Doppler ultrasound, magnetic resonance angiographic techniques and catheter angiography in evaluation of carotid stenosis. Clin Radiol 55: 912–920 (2000).PubMedCrossRefGoogle Scholar
  45. [45]
    Kim SH, Qureshi AI, Levy EI et al.: Emergency stent placement for symptomatic acute carotid artery occlusion after endarterectomy. Case report. J Neurosurg 101: 151–153 (2004).PubMedGoogle Scholar
  46. [46]
    Koch S, Rabinstein AA, Romano JG et al.: Diffusion-weighted magnetic resonance imaging in internal carotid artery dissection. Arch Neurol 61: 510–512 (2004).PubMedCrossRefGoogle Scholar
  47. [47]
    Kremer C, Mosso M, Georgiadis D et al.: Carotid dissection with permanent and transient occlusion or severe stenosis: long-term outcome. Neurology 60:271–275 (2003).PubMedGoogle Scholar
  48. [48]
    Lane D, Beevers M, Barnes N et al.: Inter-arm differences in blood pressure: when are they clinically significant? J Hypertens 20: 1089–1095 (2002).PubMedCrossRefGoogle Scholar
  49. [49]
    Lee JH, Kwon SU, Lee JH et al.: Percutaneous transluminal angioplasty for symptomatic middle cerebral artery stenosis: long-term follow-up. Cerebrovasc Dis 15:90–97 (2003).PubMedCrossRefGoogle Scholar
  50. [50]
    Levy El, Hanel RA, Boulos AS et al.: Comparison of periprocedure complications resulting from direct stent placement compared with those due to conventional and staged stent placement in the basilar artery. J Neurosurg 99: 653–660 (2003).PubMedCrossRefGoogle Scholar
  51. [51]
    Levy EL, Horowitz MB, Koebbe CJ et al.: Transluminal stent-assisted angioplasty of the intracranial vertebrobasilar system for medically refractory, posterior circulation ischemia: early results. Neurosurgery 48: 1215–1221 (2001).PubMedCrossRefGoogle Scholar
  52. [52]
    Leys D, Moulin TH, Stojkovic T et al.: DONALD Investigators. Follow-up of patients with history of cervical artery dissection. Cerebrovasc Dis 5: 43–49 (1995).Google Scholar
  53. [53]
    Liu AY, Paulsen RD, Marcellus ML et al.: Long-term outcomes after carotid stent placement treatment of carotid artery dissection. Neurosurgery 45: 1368–1373; discussion 1373–1374 (1999).Google Scholar
  54. [54]
    Lucas C, Moulin T, Deplanque D et al.: Stroke patterns of internal carotid artery dissection in 40 patients. Stroke 29: 2646–2648 (1998).PubMedGoogle Scholar
  55. [55]
    Lutsep HL, Clark WM: Association of intracranial stenosis with cortical symptoms or signs. Neurology 12: 716–718 (2000).Google Scholar
  56. [56]
    Lylyk P, Cohen JE, Ceratto R et al.: Angioplasty and stent placement in intracranial atherosclerotic stenoses and dissections. Am J Neuroradiol 23: 430–436 (2002).PubMedGoogle Scholar
  57. [57]
    Lyrer P, Engelter S. Antithrombotic drugs for carotid artery dissection. Stroke 35: 613–614 (2004).PubMedCrossRefGoogle Scholar
  58. [58]
    Malek AM, Higashida RT, Phatouros CC et al.: Endovascular management of extracranial carotid artery dissection achieved using stent angioplasty. Am J Neuroradiol 21: 1280–1292 (2000).PubMedGoogle Scholar
  59. [59]
    Melliere D, Becquemin JP, Benyahia NE et al.: Atherosclerotic disease of the innominate artery: current management and results. J Cardiovasc Surg 33: 319–323 (1992).Google Scholar
  60. [60]
    Mori T, Kazita K, Chokyu K et al.: Short-term arteriographic and clinical outcome after cerebral angioplasty and stenting for intracranial vertebrobasilar and carotid atherosclerotic occlusive disease. Am J Neuroradiol 21:249–254 (2000).PubMedGoogle Scholar
  61. [61]
    Mori T, Fukuoka M, Kazita K et al.: Follow-up study after percutaneous transluminal cerebral angioplasty. Eur Radiol 8: 403–408 (1998).PubMedCrossRefGoogle Scholar
  62. [62]
    Mori T, Fukuoka M, Kazita K et al.: Follow-up study after intracranial percutaneous transluminal cerebral balloon angioplasty. Am J Neuroradiol 19: 1525–1533 (1998).PubMedGoogle Scholar
  63. [63]
    Mori T, Mori K, Fukuoka M et al.: Percutaneous transluminal cerebral angioplasty: serial angiographic follow-up after successful dilatation. Neuroradiology 39:111–116 (1997).PubMedCrossRefGoogle Scholar
  64. [64]
    Moritani T, Ekholm S, Westesson PL: Diffusion-Weighted MR Imaging of the Brain. Springer-Verlag Berlin Heidelberg New York (2004).Google Scholar
  65. [65]
    Marks MP, Marcellus M, Norbash AM et al.: Outcome of angioplasty for atherosclerotic intracranial stenosis. Stroke 30: 1065–1069 (1999).PubMedGoogle Scholar
  66. [66]
    Morris P: Intracranial Angioplasty and Stenting. In: Interventional and Endovascular Therapy of the Nervous System. Springer-Verlag New York, Inc. pp. 121–138 (2000).Google Scholar
  67. [67]
    Mueller BT, Luther B, Waldemar H: et al. Surgical treatment of 50 carotid dissections: indications and results. J Vasc Surg 31: 980–988 (2000).CrossRefGoogle Scholar
  68. [68]
    North America Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 325: 445–453 (1991).CrossRefGoogle Scholar
  69. [69]
    National Institute of Neurological Disorders and Stroke. Carotid endarterectomy for asymptomatic internal carotid artery stenosis. J Neurol Sci 129: 76–77 (1995).CrossRefGoogle Scholar
  70. [70]
    Parsons MW, Yang Q, Barber PA et al.: Perfusion magnetic resonance imaging maps in hyperacute stroke: relative cerebral blood flow most accurately identifies tissue destined to infarct. Stroke 32: 1581–1587 (2001).PubMedGoogle Scholar
  71. [71]
    Rodriguez-Lopez JA, Werner A, Martinez R et al.: Stenting for atherosclerotic occlusive disease of the subclavian artery. Ann Vasc Surg 13: 254–260 (1999).PubMedCrossRefGoogle Scholar
  72. [72]
    Sacco RL, Kargman DE, Gu Q et al.: Race-ethnicity and determinants of intracranial atherosclerotic cerebral infarction. The Northern Manhattan Stroke Study. Stroke 26: 14–20 (1995).PubMedGoogle Scholar
  73. [73]
    Schievink WI: Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med 344: 898–906 (2001).PubMedCrossRefGoogle Scholar
  74. [74]
    Schievink WI: The treatment of spontaneous carotid and vertebral artery dissections. Curr Opin Cardiol 15:316–321 (2000).PubMedCrossRefGoogle Scholar
  75. [75]
    Schievink WI, Björnsson J, Piepgras DG: Coexistence of fibromuscular dysplasia and cystic medial necrosis in a patient with Marfan’s Syndrome and bilateral carotid artery dissections. Stroke 25: 2492–2496 (1994).PubMedGoogle Scholar
  76. [76]
    Schievink WI, Mokri B, Piepgras DG: Spontaneous dissection of cervicocephalic arteries in childhood and adolescence. Neurology 44: 1607–1612 (1994).PubMedGoogle Scholar
  77. [77]
    Schievink WI, Mokri B, O’Fallon WM: Recurrent spontaneous cervical-artery dissection. N Engl J Med 330: 393–397 (1994).PubMedCrossRefGoogle Scholar
  78. [78]
    Schievink WI, Mokri B, Whisnant JP: Internal carotid artery dissection in a community: Rochester, Minnesota, 1987–1992. Stroke 24: 1678–1680 (1993).PubMedGoogle Scholar
  79. [79]
    Schillinger M, Haumer M, Schillinger S et al.: Risk stratification for subclavian artery angioplasty: is there an increased rate of restenosis after stent implantation? J Endovasc Ther 8: 550–557 (2001).PubMedCrossRefGoogle Scholar
  80. [80]
    Schumacher HC, Khaw AV, Meyers PM et al.: Intracranial angioplasty and stent placement for cerebral atherosclerosis. J Vasc Interv Radiol 15: 123–132 (2004).Google Scholar
  81. [81]
    Schwarze JJ, Babikian V, DeWitt LD et al.: Longitudinal monitoring of intracranial arterial stenoses with transcranial Doppler ultrasonography. J Neuroimaging 4: 182–187 (1994).PubMedGoogle Scholar
  82. [82]
    Segura T, Serena J, Castellanos M et al.: Embolism in acute middle cerebral artery stenosis. Neurology 56:497–501 (2001).PubMedGoogle Scholar
  83. [83]
    Shadman R, Criqui MH, Bundens WP et al.: Subclavian artery stenosis: prevalence, risk factors, and association with cardiovascular diseases. J Am Coll Cardiol 44: 618–623 (2004).PubMedCrossRefGoogle Scholar
  84. [84]
    Silbert PL, Mokri B, Schievink WI: Headache and neck pain in spontaneous internal carotid and vertebral artery dissections. Neurology 45: 1517–1522 (1995).PubMedGoogle Scholar
  85. [85]
    SSYLVIA Study Investigators: Stenting of Symptomatic Atherosclerotic Lesions in the Vertebral or Intracranial Arteries (SSYLVIA): study results. Stroke 35: 1388–1392 (2004).CrossRefGoogle Scholar
  86. [86]
    Sztriha LK, Voros E, Sas K et al.: Favorable early outcome of carotid artery stenting without protection devices. Stroke 35: 2862–2866 (2004).PubMedCrossRefGoogle Scholar
  87. [87]
    The EC/IC-Bypass Study Group: Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke. Results of an international randomized trial. N Engl J Med 313: 1191–1200 (1985).CrossRefGoogle Scholar
  88. [88]
    Thijs VN, Albers GW: Symptomatic intracranial atherosclerosis: outcome of patients who fail antithrombotic therpay. Neurology 55: 490–497 (2000).PubMedGoogle Scholar
  89. [89]
    Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) Trial Investigators: Design, progress and challenges of a double-blind trial of warfarin versus aspirin for symptomatic intracranial arterial stenosis. Neuroepidemiology 22: 106–117 (2003).CrossRefGoogle Scholar
  90. [90]
    Wityk RJ, Lehman D, Klag M et al.: Race and sex differences in the distribution of cerebral atherosclerosis Stroke 27: 1974–1980 (1996).PubMedGoogle Scholar
  91. [91]
    Wong KS, Li H, Lam WW et al.: Progression of middle cerebral artery occlusive disease and its relationship with further vascular events after stroke. Stroke 33: 532–536 (2002).PubMedCrossRefGoogle Scholar
  92. [92]
    Wong KS, Gao S, Chan YL et al.: Mechanisms of acute cerebral infarctions in patients with middle cerebral artery stenosis: a diffusion-weighted imaging and microemboli monitoring study. Ann Neurol 52: 74–81 (2002).PubMedCrossRefGoogle Scholar
  93. [93]
    Wong KS, Huang YN, Gao S et al.: Intracranial stenosis in Chinese patients with acute stroke. Neurology 50: 812–813 (1998).PubMedGoogle Scholar
  94. [94]
    Wylie EJ, Effeney DJ: Surgery of the aortic arch branches and vertebral arteries. Surg Clin North Am 59: 669–680 (1979).PubMedGoogle Scholar

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© Springer-Verlag/Wien 2007

Authors and Affiliations

  • B. Butz
    • 1
  1. 1.Department of RadiologyUniversity HospitalRegensburgGermany

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