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Some observations on aneurysms of the proximal internal carotid artery
Insights
Proximal internal carotid artery (PICA) aneurysms are rare, often found incidentally in women with subarachnoid hemorrhage. Multiple aneurysms were common, with distal lesions typically causing the hemorrhage.
Area of Science:
- Neurology
- Vascular Surgery
- Radiology
Background:
- Subarachnoid hemorrhage (SAH) is a critical condition often caused by ruptured intracranial aneurysms.
- Proximal internal carotid artery (PICA) aneurysms are uncommon but significant cerebrovascular lesions.
Purpose of the Study:
- To characterize the clinical and angiographic features of proximal internal carotid artery aneurysms.
- To investigate the association of PICA aneurysms with other cerebrovascular abnormalities and patient demographics.
Main Methods:
- Retrospective analysis of 36 patients with 41 PICA aneurysms.
- Review of angiographic findings, including aneurysm location, multiplicity, and associated vascular anomalies.
- Analysis of patient demographics, focusing on sex and presenting symptoms.
Main Results:
- A striking preponderance of female patients was observed.
- A high incidence of multiple intracranial aneurysms was noted, with PICA aneurysms frequently being incidental findings.
- Infundibulum at the origin of the posterior communicating artery was unusually common.
- The ophthalmic artery origin was proposed as a landmark for dural penetration.
Conclusions:
- PICA aneurysms present unique demographic and angiographic characteristics, often co-occurring with distal internal carotid artery aneurysms.
- The high association with female patients and multiple aneurysms warrants further investigation into underlying pathogenetic mechanisms.
Abstract:
The author reports on 41 aneurysms of the proximal internal carotid artery (PICA) demonstrated in 36 patients with subarachnoid hemorrhage. The patients included a striking preponderance of women, and there was a high incidence of multiple aneurysms. In cases with multiple aneurysms the PICA aneurysm was usually found incidentally, a more distal aneurysm on the internal carotid artery being the source of hemorrhage. An infundibulum at the origin of a posterior communicating artery was unusually common in these patients. The origin of the ophthalmic artery is proposed as the angiographic landmark of the level at which the internal carotid artery penetrates the dura mater.