Basilar Apex Aneurysms in the Setting of Carotid Artery Stenosis: Case Series and Angiographic Anatomic Study
Author Type(s)
Resident/Fellow
Document Type
Article
Publication Date
January 2019
DOI
10.2174/1567202616666190129150403
Journal Title
Current Neurovascular Research
Abstract
BACKGROUND: Intracranial aneurysms (IAs) are life-threatening lesions known within the literature to be found incidentally during routine angiographic workup for carotid artery stenosis (CAS). As IAs are associated with vascular shear stress, it is reasonable to expect that altered flow demands within the anterior circulation, such as with CAS, increase compensatory flow demands via the Circle of Willis (COW) and may induce similar stress at the basilar apex. OBJECTIVE: We present a series of nine unruptured basilar apex aneurysms (BAA) with CAS and a comparative radiographic analysis to BAA without CAS. METHODS: Twenty-three patients with BAA were retrospectively identified using records from 2011 to 2016. CAS by NASCET criteria, morphology of BAA, competency of COW, and anatomic relationships within the posterior circulation were examined independently by a neuroradiologist using angiographic imaging. RESULTS: Nine (39%) of the twenty-three BAA patients had CAS, with six having stenosis >/=50%. Four (67%) of the patients with >/=50% CAS demonstrated aneurysm flow angles contralateral to the side with highest CAS. Additionally, the angle between the basilar artery trajectory and aneurysm neck was observed to be smaller in patients with >/=50% CAS (61 vs 74 degrees). No significant differences in COW patency, posterior circulation morphology, and degree of stenosis were observed. CONCLUSION: Changes in the cervical carotid arteries may lead to blood flow alterations in the posterior circulation that increase the propensity for BAA formation. Posterior circulation imaging can be considered in CAS patients to screen for BAA.
Recommended Citation
Rosenbaum, M., Heiferman, D., Raslan, O., Martin, B., Dominguez, J., de la Pena, P., Ashley, W., Rosenblum, J., & Germanwala, A. (2019). Basilar Apex Aneurysms in the Setting of Carotid Artery Stenosis: Case Series and Angiographic Anatomic Study. Current Neurovascular Research, 16 (1), 12-18. https://doi.org/10.2174/1567202616666190129150403