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Joseph F. Cusick and David Daniels

A lthough spontaneous restoration of flow through a totally occluded internal carotid artery (ICA) is an unusual event, its occurrence after spontaneous arterial dissection is gaining recognition. 5, 6, 8 The paucity of clinical reports regarding this entity, believed to be more common than previously recognized, has resulted in an incomplete clarification of its pathogenesis, natural history, and treatment. Spontaneous reversal of angiographically verified total ICA occlusion parallels the reversal of preocclusive stenosis following spontaneous arterial

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Shigekiyo Fujita

A large majority of internal carotid artery (ICA) aneurysms grow toward the posterior or posterolateral aspect of the parent artery. 1 The fenestrated clips that are currently available are hard to apply except when the aneurysm protrudes toward the posteromedial aspect of the ICA. In addition, when an ICA aneurysm becomes larger, the diameter of the neck enlarges in the direction of the major axis of the parent artery. To clip the aneurysm safely, the ICA should be inserted into the window of a fenestrated clip with blades bent almost at a right angle so

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Ian Johnston

T he finding of bilateral intracavernous aneurysms of the internal carotid artery (ICA) is rare. Since the initial report of Sir Gilbert Blane in 1800 3 there have been only 12 reported cases, 16 with a further three cases referred to elsewhere. 10 In only one of the 12 cases collected by Wilson and Myers 16 was surgical treatment attempted. 13 In recent years, Parkinson, 11, 12 in particular, has established the feasibility of a direct approach to the ICA within the cavernous sinus. Such an approach was used in the present case and is described below

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Brian C. Fitzpatrick, Robert F. Spetzler, Jeffrey L. Ballard, and Richard S. Zimmerman

L esions associated with the high cervical internal carotid artery (ICA) or lesions extending into the skull base that cannot be approached directly may be treated with a bypass or trapping procedure. Ideally, the bypass graft should be short and it should provide blood flow that approximates that of the bypassed ICA. The damaged vessel should be trapped to prevent the development of further emboli. A saphenous vein cervical-to-petrous ICA bypass meets these criteria. Miyazaki, et al. , 8 described a cervical-to-petrous ICA bypass procedure using a saphenous

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David J. Lubbers and Thomas A. Tomsick

wish to undergo an invasive diagnostic procedure; therefore, CT scanning of the neck and head was performed with contrast enhancement. Contiguous 5-mm sections, obtained from C-3 to the base of the skull, demonstrated dissection changes in the wall of the cervical left ICA ( Fig. 1 ). The intracranial images were normal. A diagnosis of ICA dissection was made and confirmed 2 days later by cerebral angiogram ( Fig. 2 ). Fig. 1. Computerized tomography, axial image, at the C-1 vertebral level showing a normal right internal carotid artery (ICA, open arrow

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Jason A. Heth, Christopher M. Loftus, John G. Piper, and William Yuh

S tring sign is customarily thought to be an indicator of critical stenosis of the internal carotid artery (ICA) requiring carotid endarterectomy on an emergency basis to prevent occlusion of the vessel. We present a patient with left hemisphere transient ischemic attacks (TIAs) and what appeared on angiography to be a classic string sign in the right cervical carotid artery. On examination the patient was found to have hypoplasia of the right ICA throughout its course. This is a rare anomaly, but we believe that when a string sign is detected on angiography

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Daniel G. Nehls, Stephen R. Marano, and Robert F. Spetzler

T ransient ischemic attacks and strokes can occur when a major vessel supplying the brain becomes intermittently occluded. There are numerous reports of intermittent vertebral artery occlusion due to osteophytes, 1 atlantoaxial subluxation, 3 and fibrous bands of the longus colli muscle. 4 Intermittent positional occlusion of a persistent hypoglossal artery has also been implicated in producing transient episodes of syncope. 2 In this paper, we present a case in which angiograms demonstrated occlusion of the internal carotid artery (ICA) when the patient

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Eugenio Pozzati, Giulio Gaist, and Franco Servadei

M ost traumatic intracranial aneurysms are located on the middle meningeal artery and peripheral branches of the anterior and middle cerebral arteries. 1, 3–5, 8, 9, 13, 15, 16, 18, 20, 21, 23, 28 Traumatic aneurysms of the intracranial internal carotid artery (ICA) are encountered mainly in its petrous and cavernous portion, 3, 24, 28 and are often associated with basal skull fractures; the supraclinoid segment is seldom affected. 13, 30 Giant traumatic aneurysms of the intracranial ICA have been reported only twice; 5, 22 in both instances, the infra

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Bahram Mokri, David G. Piepgras, and O. Wayne Houser

practical purposes, spontaneous dissections and dissections with a history of trivial trauma appear to be distinctly different from dissections related to definite severe head or neck trauma. 21 Extracranial internal carotid artery (ICA) dissections are uncommon but not rare. As clinicians and radiologists have become more familiar with the clinical and angiographic features of this entity, an increasing number of cases have been reported and several fairly sizeable series have been published during the last two decades. 1, 2, 4, 5, 7, 11–15, 17, 18, 20, 22, 23, 25

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Robert C. Rostomily, Marc R. Mayberg, Joseph M. Eskridge, Robert Goodkin, and H. Richard Winn

percutaneous transluminal angioplasty for atherosclerotic stenoses of the petrous or intracranial portion of the internal carotid artery (ICA) or distal cerebral vessels. 16, 18 Intracranial ICA stenosis due to atherosclerosis has been associated with significant stroke and mortality rates, particularly if the lesion is symptomatic or exists in tandem with extracranial ICA stenosis. 3, 14 Although extracranial-to-intracranial artery bypass procedures have been utilized previously for these lesions, a randomized prospective trial demonstrated no benefit for this procedure