Artery internal carotid

Phillips DA, Davis MA, Fisher M. Selective embolization and clot dissolution with tPA in the internal carotid artery circulation of the rabbit. AJNR Am J Neuroradiol. 1988 9 899-902. 

Internal Carotid Artery Occlusion Acute stroke due to a distal ICA T (T = terminus) occlusion carry a much worse prognosis than MCA occlusions. In a recent analysis of 24 consecutive patients (median NIHSS 19) presenting with T occlusions of the ICA who were treated by lAT using urokinase at an average of 237 minutes from symptom onset, only four patients (16.6%) had a favorable outcome at 3 months. Partial recanalization of the intracranial ICA was achieved in 15 (63%), of the MCA in 4 (17%), and of the ACA in 8 patients (33%). Complete recanalization did not occur. The presence of good leptomeningeal collaterals and age <60 years were the only predictors of a favorable clinical outcome. New treatment strategies, such as the combination of IV rt-PA and lAT, or the use of new mechanical devices may improve the outcome in these patients. 

Arnold M, Nedeltchev K, Mattie HP, Loher TJ, Stepper F, Schroth G, Brekenfeld C, Sturzenegger M, Remonda L. Intra-arterial thrombolysis in 24 consecutive patients with internal carotid artery T occlusions. J Neurol Neurosurg Psychiatry 2003 74 739-742. 

Zaidat OO, Suarez Jl, Santillan C, Sunshine JL, Tarr RW, Paras VH, Selman WR, Landis DM. Response to intra-arterial and combined intravenous and intra-arterial thrombolytic therapy in patients with distal internal carotid artery occlusion. Stroke 2002 33 1821-1826. 

Jovin TG, Gupta R, Uchino K, Jungreis CA, Wechsler LR, Hammer MD, Tayal A, Horowitz MB. Emergent stenting of extracranial internal carotid artery occlusion in acute stroke has a high revascularization rate. Stroke 2005 36 2426-2430. 

Bellon RJ, Putman CM, Budzik RF, Pergolizzi RS, Reinking GF, Norbash AM. Rheolytic thrombectomy of the occluded internal carotid artery in the setting of acute ischemic stroke. Am J Neuroradiol 2001 22 526-530. 

CEA involves exposure of the carotid bifurcation in the neck to a point along the internal carotid artery (ICA) beyond which the atherosclerotic plaque terminates. 

Touho H, Morisako T, Hashimoto Y, Karasawa J. Embolectomy for acute embolic occlusion of the internal carotid artery bifurcation. Surg Neurol 1999 51 313-320. 

Clinical trials and meta-analyses have demonstrated that early carotid endarterectomy (CEA) is the preferred treatment for most patients with severe symptomatic internal carotid artery (ICA) stenosis and selected patients with moderate disease.However, CEA is often delayed in chnical practice, or may not be appropriate in some patients due to an unfavorable risk-benefit profile. In these settings, it is reasonable to consider acute antithrombotic treatment to prevent early recurrent stroke. 

Lucas C, Moulin T, Deplanque D, Tatu L, Chavot D. Stroke patterns of internal carotid artery dissection in 40 patients. Stroke 1998 29 2646-2648. 

Engelter S, Lyrer P, Kirsch E, Steck AJ. Long-term follow-up after extracranial internal carotid artery dissection. Eur Neurol 2000 44 199-204. 

Lu CJ, Kao HL, Sun Y, Liu HM, Jeng JS, Yip PK, Lee YT. The haemodynamic effects of internal carotid artery stenting a study with color-coded duplex sonography. Cerebro-vasc Dis 2003 15 264-269. 

Suwanwela N, Can U, Furie KL, Southern JF, Macdonald NR, Ogilvy CS, Hansen CJ, Buonanno FS, Abbott WM, Koroshetz WJ, Kistler JR Carotid Doppler ultrasound criteria for internal carotid artery stenosis based on residual lumen diameter calculated from en bloc carotid endarterectomy specimens. Stroke 1996 27(11) 1965-1969. 

Erickson SJ, Mewissen MW, Foley WD, Lawson TL, Middleton WD, Quiroz FA, Macrander S J, Lipchik EO. Stenosis of the internal carotid artery assessment using color... 

Polak IF, Dobkin GR, O Leary DH, Wang AM, Cutler SS. Internal carotid artery stenosis accuracy and reproducibility of color-Doppler-assisted duplex imaging. Radiology 1989 173(3) 793-798. 

Ghilardi G, Biondi ML, Turri O, Guagnellini E, Scorza R. Internal carotid artery occlusive disease and polymorphisms of fractalkine receptor CX3CR1 a genetic risk factor. Stroke 2004 35(6) 1276-1279. 

Although the brain constitutes only 2% of body weight, it receives approximately 15% of the blood supply and consumes nearly 20% of the total oxygen and glucose available to the body. In order to supply these essential nutrients for brain function, there must be a consistent and rapid blood supply to the brain in order that the brain cells may function. This is supplied by the cerebral arteries derived from the internal carotid arteries which branch over the surface of the brain and send smaller branches into the deeper subcortical structures. The capillaries are highly branched and it has been calculated that every nerve cell is no more than 40-50 fim from a capillary. 

Sensitivity was improved by at least two orders of magnitude with the internal carotid artery perfusion technique [43]. An outline of the method is given in Figure 2.4. Here, the extraction can be measured over a time frame of 15 s to 10 min or more, while maintaining the... 

Figure 2.4. In vivo measurement of blood-brain barrier (BBB) permeability, (a) Internal carotid artery perfusion technique (i) in the rat. Other branches of the carotid artery are ligated or electrically coagulated (o, occipital artery p, pterygopalatine artery). The external carotid artery (e) is cannulated and the common carotid artery (c) ligated. Perfusion time may range from 15 s to 10 min, depending on the test substance. It is necessary to subtract the intravascular volume, Vo, from (apparent volume of distribution), to obtain true uptake values and this may be achieved by inclusion of a vascular marker in the perfusate, for example labelled albumin. Time-dependent analysis of results in estimates of the unidirectional brain influx constant Ki (pi min which is equivalent within certain constraints to the PS product. BBB permeability surface area product PS can be calculated from the increase in the apparent volume of distribution Vd over time. Capillary depletion, i.e. separation of the vascular elements from the homogenate by density centrifugation, can discriminate capillary uptake from transcytosis. (b) i.v. bolus kinetics. The PS product is calculated from the brain concentration at the sampling time, T, and the area under the plasma concentration-time curve, AUC.

Carotid revascularization, initially by CEA, was introduced in early 1950s as a method to prevent stroke due to atherosclerosis of the carotid bifurcation and internal carotid artery (ICA). At least four prospective randomized trials have demonstrated... 

Belan A, Vesela M, Vanek I, Weiss K, Peregrin JH. Percutaneous transluminal angioplasty of fibromuscular dysplasia of the internal carotid artery. Cardiovasc Intervent Radiol 1982 5 79-81. 

Bockenheimer SA, Mathias K. Percutaneous transluminal angioplasty in arteriosclerotic internal carotid artery stenosis. AJNRAmJ Neuroradiol 1983 4 791-792. 

HassoAN, Bird CR, Zinke DE, Thompson JR. Fibromuscular dysplasia of the internal carotid artery percutaneous transluminal angioplasty. AJR Am J Roentgenol 1981 136 955-960. 

---