Internal Carotid Stenosis Associated with Compression by Hyoid Bone.
Ombretta Martinelli1, Mauro Fresilli1, Jihad Jabbour1
1Vascular Surgery Division, "Paride Stefanini" Department, Policlinico "Umberto I", Sapienza University of Rome, Rome, Italy.
Annals of Vascular Surgery
|January 27, 2019
Summary
Hyoid bone protrusion can compress the internal carotid artery (ICA), leading to severe carotid stenosis and stroke. Surgical removal of plaques and correction of ICA course is recommended over endovascular treatment for such cases.
Area of Science:
- Vascular Surgery
- Cerebrovascular Disease
- Atherosclerosis Research
Background:
- Atherosclerotic plaques rarely occur with hyoid bone protrusion into the internal carotid artery (ICA).
- Hyoid bone proximity can cause turbulent flow and shear stress, promoting plaque formation.
- Elongated ICAs may alter course, increasing mechanical interference with the hyoid bone.
Observation:
- A patient presented with transient ischemic attack and >70% right carotid stenosis.
- Stenosis was attributed to compression of an elongated ICA by the hyoid bone.
- The patient had atherosclerotic plaques and adhesions to the hyoid bone's greater horn.
Findings:
- Surgical intervention successfully removed the plaque and corrected the ICA's anomalous course.
- Adhesions between the ICA and the hyoid bone were lysed.
- The hyoid bone was identified as a remote cause of carotid artery injury and atherosclerotic lesions.
Implications:
- External carotid artery compression necessitates open surgery, not endovascular treatment.
- Understanding hyoid bone's role in carotid disease can improve diagnosis and treatment strategies.
- This case highlights the importance of considering anatomical variations in cerebrovascular disease management.
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