Neurovascular anatomy for carotid angiography and interventions

The purpose of this chapter is to review normal and variant vascular anatomy of the aortic arch and the extracranial and intracranial cerebrovasculature. There is specific emphasis placed on cerebrovascular anatomy as it pertains to carotid arteriography and carotid angioplasty. The ability to interpret cerebrovascular images is critical to providing high-quality patient care to patients with carotid occlusive disease. Variations in arch and intracerebral arch anatomy are usually irrelevant to open carotid surgery, but may be critical when performing carotid interventions. Understanding arch anatomy is integral to guiding sheath placement in the common carotid artery. Recognizing the presence of intracerebral variation or pathology may significantly influence periprocedural technique and patient management during carotid stent placement. There is a significant incidence of intracerebral pathology in patients having angiograms for extracranial occlusive disease, as high as 20% in some series (1). In the case of incidental findings, such as an aneurysm, it is critical to be able to localize the abnormality and communicate effectively with the consulting neurosurgeon or neurologist.