Page 7 - Carotid and peripheral vascular interventions textbook
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CHAPTER 6 • CAROTID ARTERY DISEASE





                                             Middle meningeal artery
                                     Branch of middle
                                     cerebral artery


                                            Middle cerebral artery
                                                                          Ophthamic artery
                                                  Posterior
                                                 communicating
                                                   artery
                       Posterior
                        cerebral
                        artery
                                    Basilar artery                          Angular artery


                                                                             Infraorbital artery
                   Occipital artery
                                                                                          Collateral
                                                                               ICA        circulation
                                                      Maxillar artery  Buccal artery  occlusion
                      Vertebral artery                                                            Middle  Middle
                                                                                              Collateral   meningeal
                                                                                                  meninigeal
                                                                                              circulation  artery
                                                                                                  artery
                               ICA occlusion
                                                                                          ICA
                                                      External                           occlusion
                                                      carotid
                                    Common
                                     carotid           artery
                                     artery
                 Figure 6-7. Collateral circulation between the internal carotid artery (ICA), external carotid artery, and vertebrobasilar artery supplies oxygenated   135
                 blood to brain territories distal to an occluded ICA. (Redrawn from Erickson K, Cole D. Carotid artery disease: stenting vs endarterectomy. British
                 Journal of Anaesthesia. 1010:105 (suppl 1): i34–i49, with permission from Elsevier)

                 artery (Fig. 6-7). The ophthalmic artery obtains blood
                                                                                    Posterior
                 f ow from different collateral branches of the ECA,                communicating
                                                                                    artery   PCA
                 and the backward f ow within the ophthalmic artery
                                                                                            Trigeminal artery
                 eventually f lls the proximal subarachnoid part of
                 the ICA. Additionally, the vertebral artery can interface                    PICA
                                                                     Otic artery                  Proatlantal
                 with the carotid system by the ascending pharyngeal                              intersegmental
                                                                 Hypoglossal artery               artery
                 as well as the occipital ECA branches. Following
                                                                         ICA
                 vertebral artery blockage, the occipital artery can supply
                 distal f ow to the terminal vertebral artery segment via                        Occipital-vertebral
                                                                                                 anastomoses
                 intramuscular communication.                          ECA
                     Important intracranial and extracranial collateral                       Vertebral
                 pathways supply blood f ow to brain territories which
                 are distant to a stenosed ICA, including                                     Cervical
                     •  ICA to the contralateral ICA - via interhemispheric   RCCA            intersegmental
                                                                   Right                      artery
                      circulation via the anterior communicating artery   vertebral
                                                                   artery
                     •  Vertebrobasilar system to the ICA - via the
                      trigeminal  artery,  posterior  communicating                             LCCA
                      artery, hypoglossal artery, otic artery, together with
                      the proatlantal intersegmental artery (Fig. 6-8)
                     •  ECA to the ICA - by the internal maxillary branch
                      of the ECA to the ophthalmic branch of the ICA   Figure 6-8. Carotid artery and vertebrobasilar collateral anatomoses.
                     •  ECA to the vertebral artery - by the occipital branch   (Adapted from Cho L, Mukherjee D. Basic cerebral anatomy for the
                                                                 carotid interventionalists: The intracranial and extracranial vessels.
                      of the ECA                                 Catheter Cardiovasc Interv. 2006;68:104-111.)
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