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The internal carotid artery siphon in children and adolescents
M A Bergevin1, C C Daugherty, K E Bove
1Department of Pathology, Children's Hospital Medical Center, Cincinnati, OH 45229-2899.
Insights
This study found common internal elastic lamina lesions and calcification in the carotid siphon of young individuals. These vascular changes, prevalent even in the absence of stroke, warrant further investigation into their role in cerebrovascular events.
Area of Science:
- Vascular Biology
- Neuropathology
- Pediatric Pathology
Background:
- Stroke in children and adolescents is rare and not well understood.
- Carotid artery siphon lesions are implicated in fatal strokes in young individuals.
Purpose of the Study:
- To investigate the prevalence and characteristics of internal carotid artery siphon lesions in a young autopsy cohort.
- To determine if these lesions are associated with stroke or other cerebrovascular pathologies.
Main Methods:
- Examination of the internal carotid artery siphon in 24 unselected autopsies (age range: 10 days to 38 years).
- Histopathological analysis of intimal lesions, including elastic lamina splitting, smooth muscle proliferation, and calcification.
Main Results:
- All cases exhibited intimal lesions in the carotid siphon.
- Two types of lesions were identified: (1) splitting/duplication of the internal elastic lamina with smooth muscle proliferation, increasing with age; (2) internal elastic calcification, present in individuals over 9 years old and increasing with age.
- Lesion severity and distribution were not significantly different by sex, race, or cause of death (stroke was not the cause of death in any case).
Conclusions:
- The internal carotid artery siphon frequently shows intimal lesions, including elastic lamina abnormalities and calcification, even in young individuals without a history of stroke.
- The precise relationship between these common vascular lesions and the pathogenesis of stroke or dissecting aneurysms remains unclear and requires further research.
Abstract:
We observed significant lesions of the carotid artery siphon in two young subjects with fatal stroke. Because stroke in children and adolescents is uncommon and poorly understood, we examined the internal carotid artery in the 'siphon' of the skull in 24 unselected, but nearly consecutive autopsies. The age range was 10 days to 38 years, with 11 males and 13 females, six blacks, and 18 whites. In no case was stroke the cause of death. Intimal lesions of two types were found in the carotid siphon of all cases. (1) The first was focal splitting and/or duplication of the internal elastic lamina with variable proliferation of smooth muscle. The resulting 'fibrous' plaques or cushions, when severe, were usually found at natural bends in the artery. The number and severity of this type of lesion increased with age, but there were no differences in severity or distribution when compared by sex, race, or mode of death. (2) The second was internal elastic calcification which was found in all cases older than 9. This was increasingly severe with age. Although the frequency of the vascular lesions was surprisingly high, the relationship of either type to dissecting aneurysm or other stroke lesion remains unclear.