Embolization in the External Carotid Artery

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Presentation transcript:

Embolization in the External Carotid Artery Tony P. Smith, MD Journal of Vascular and Interventional Radiology Volume 17, Issue 12, Pages 1897-1913 (December 2006) DOI: 10.1097/01.RVI.0000247301.64269.27 Copyright © 2006 Society of Interventional Radiology Terms and Conditions

Figure 1 Anteroposterior and lateral angiograms of the ECA. (a) Lateral view of ECA shows occlusion of ICA (arrow). This lateral view nicely demonstrates the infraorbital artery (arrowheads) from the IMA (3). Branches of the distal facial artery (asterisk) demonstrate how this vessel contributes supply to the nasal cavity participating in epistaxis (1, lingual artery; 2, facial artery; 3, IMA; 4, MMA; 5, superficial temporal artery; 6, occipital artery; 7, ascending pharyngeal artery). (b) Frontal view of ECA in the same patient demonstrates that most vessels are overlapped in this view except for the distal IMA, particularly the sphenopalatine artery (arrow). Arrowhead shows distal branches of the facial artery (1, MMA; 2, occipital artery). Journal of Vascular and Interventional Radiology 2006 17, 1897-1913DOI: (10.1097/01.RVI.0000247301.64269.27) Copyright © 2006 Society of Interventional Radiology Terms and Conditions

Figure 2 Lateral view of a common carotid injection in which the ICA is occluded. (a) Early intracranial views demonstrate filling of the ophthalmic artery (arrow) via ethmoidal collaterals (arrowheads). Flow in the ophthalmic artery is retrograde and fills the ICA (gray arrow). (b) Later view demonstrates complete filling of the intracranial ICA supply via retrograde flow from the ophthalmic artery. Journal of Vascular and Interventional Radiology 2006 17, 1897-1913DOI: (10.1097/01.RVI.0000247301.64269.27) Copyright © 2006 Society of Interventional Radiology Terms and Conditions

Figure 3 Embolization of frontal meningioma. (a) Lateral view of angiogram after partial embolization of MMA for meningioma (arrowhead). Note the prominent choroidal blush (arrows) demonstrating supply to the orbital contents. Proximal coils were placed in a feeding artery (asterisk) because particle embolization was not considered safe in this patient. Angiography of the MMA should always include the orbit on at least one view to rule out the choroidal blush. (b) Internal carotid infection shows absence of ophthalmic artery. Journal of Vascular and Interventional Radiology 2006 17, 1897-1913DOI: (10.1097/01.RVI.0000247301.64269.27) Copyright © 2006 Society of Interventional Radiology Terms and Conditions

Figure 4 Images of the right common carotid artery before and after embolization in a 59-year-old man with a right carotid body paraganglioma. (a) Image before embolization demonstrates a hypervascular mass (arrow), which splays the carotid bifurcation. (b) Image after embolization demonstrates minimal residual flow to the carotid body tumor, which was successfully removed surgically. Journal of Vascular and Interventional Radiology 2006 17, 1897-1913DOI: (10.1097/01.RVI.0000247301.64269.27) Copyright © 2006 Society of Interventional Radiology Terms and Conditions

Figure 5 Lateral ECA angiography in a 13-year-old boy with epistaxis and JNA. (a) Hypervascular mass (arrow) in the nasal cavity bed is supplied solely from the IMA (1). The MMA (2) is well-demonstrated. In addition, the transition of this artery to the intracranial aspect provides a characteristic bend (arrowhead) at the foramen spinosum. (b) Images obtained after embolization demonstrate an excellent result with only minimal residual hypervascularity (arrow). This tumor was successfully removed surgically. Journal of Vascular and Interventional Radiology 2006 17, 1897-1913DOI: (10.1097/01.RVI.0000247301.64269.27) Copyright © 2006 Society of Interventional Radiology Terms and Conditions

Figure 6 Lateral views of right common carotid artery injection in a 14-year-old girl with a gunshot wound. (a) Injury includes ICA and ECA. The ICA was occluded several days earlier (arrowheads). Current view demonstrates injury to the ECA just superior to the facial artery. (b) Occlusion of ECA just above the facial artery with coils (arrows). Note that injury site is occluded above and below by the coils to prevent late development of an arteriovenous fistula via retrograde flow. Journal of Vascular and Interventional Radiology 2006 17, 1897-1913DOI: (10.1097/01.RVI.0000247301.64269.27) Copyright © 2006 Society of Interventional Radiology Terms and Conditions