Toward an endovascular internal carotid artery classification system.

Area of Science:

• Vascular Neurology
• Interventional Neuroradiology
• Medical Imaging

Background:

• Existing classification schemes for internal carotid artery (ICA) aneurysms are often surgically driven.
• There is a need for a classification system optimized for endovascular approaches.

Purpose of the Study:

• To propose a novel angiography-driven classification system for ICA aneurysms.
• To enhance the description of ICA anatomy from an endovascular perspective.

Main Methods:

• Review of existing ICA aneurysm classifications.
• Development of a new scheme based on analysis of angiographic and cross-sectional databases.
• Identification and naming of seven distinct ICA segments.

Main Results:

• A new seven-segment classification (cervical, petrous, cavernous, paraophthalmic, posterior communicating, choroidal, terminus) is proposed.
• The classification acknowledges uncertainty in localizing aneurysms near dural rings.
• It emphasizes common endovascular treatment features over surgical distinctions.

Conclusions:

• The proposed classification optimizes ICA description for endovascular interventions.
• It offers standardized nomenclature for outcome tracking, clinical trials, and physician communication.
• This scheme addresses the increasing endovascular treatment of complex aneurysms not fitting current classifications.