Extracranial cerebrovascular evaluation
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Extracranial Cerebrovascular Evaluation. Anatomy. Carotid Artery Anatomy. Branches of the Aortic Arch Innominate Left CCA Left Subclavian Innominate branches into Right CCA Right Subclavian. Rt. Common Carotid A. Rt. Subclavian A. Lt. Common Carotid A. Lt. Subclavian A. Innominate A.

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Carotid artery anatomy
Carotid Artery Anatomy

  • Branches of the Aortic Arch

    • Innominate

    • Left CCA

    • Left Subclavian

  • Innominate branches into

    • Right CCA

    • Right Subclavian


Rt. Common Carotid A

Rt. Subclavian A

Lt. Common Carotid A

Lt. Subclavian A

Innominate A


Carotid artery anatomy1
Carotid Artery Anatomy

  • Subclavian divided into three parts by Scaleneus Anterior muscle.

  • First part lies medial to the muscle.

  • Second part lies posterior to the muscle.

  • Third part lies lateral to the muscle


Carotid artery anatomy2
Carotid Artery Anatomy

  • Branches of the first part of the Subclavian Artery

    • Vertebral Artery

    • Internal Mammary

    • Thyrocervical Trunk

  • Thyrocervical Trunk

    • Suprascapular

    • Inferior Thyroid

    • Transverse Cervical


Carotid artery anatomy3
Carotid Artery Anatomy

Right CCA

  • Begins at the bifurcation of the Innominate artery behind the right sternocostal joint.

  • Has only a cervical portion.


Carotid artery anatomy4
Carotid Artery Anatomy

Left CCA

  • Springs from the highest part of the arch of the aorta to the left of and in a plane posterior to the Innominate artery.

  • Has a thoracic and cervical portion.


Carotid artery anatomy5
Carotid Artery Anatomy

Left CCA

  • The thoracic portion begins at the arch of the aorta and ascends in the superior mediastinum to the level of the left sternocostal joint where it becomes continuous with the cervical portion


Carotid artery anatomy6
Carotid Artery Anatomy

Cervical Portion of Both CCA

  • Ascends obliquely upwards from the SCJ

  • Ends at the level of the upper border of the thyroid cartiage where it divides into:

    • Internal Carotid Artery (ICA)

    • External Carotid Artery (ECA)


Carotid artery anatomy7
Carotid Artery Anatomy

ICA

  • Begins at the level of the upper border of the thyroid cartiage.

  • Consist of four portions.

    • Cervical

    • Petrous

    • Cavernous

    • Cerebral


Carotid artery anatomy8
Carotid Artery Anatomy

Cervical portion

  • Runs perpendicularly upward in front of the transverse processes of the upper three cervical vertebrae.

  • Ends at the carotid canal in the petrous portion of the temporal bone.


Carotid artery anatomy9
Carotid Artery Anatomy

Petrous portion

  • Enters the carotid canal in the petrous portion of the temporal bone.

  • Ascends a short distance.

  • Curves forward and medialward.

  • Ascends again as it leaves the skull.


Carotid artery anatomy10
Carotid Artery Anatomy

Cavernous Portion

  • Artery is situated between the layers of the dura mater forming the cavernous sinus.

  • It is covered by the lining membrane of the sinus.

  • Ascends towards the posterior clinoid process.

  • Then passes forward by the side of the body of the sphenoid bone.


Carotid artery anatomy11
Carotid Artery Anatomy

Cavernous Portion

  • Curves upward on the medial side of the anterior clinoid process.

  • Perforates the dura mater forming the roof of the sinus.


Carotid artery anatomy12
Carotid Artery Anatomy

Cerebral Portion

  • After piercing the dura mater on the medial side of the clinoid process

  • Passes between the optic and occulomotor nerves to the anterior perforated substance at the medial extremity of the lateral cerebral fissure.

  • Gives off its terminal branches


Carotid artery anatomy13
Carotid Artery Anatomy

Ophthalmic Artery

  • Divided into two groups

  • Orbital group – distributed to the orbit and surrounding parts

  • Occular group – distributed to the muscles and bulb of the eye.


Carotid artery anatomy14
Carotid Artery Anatomy

Orbital group

  • Lacrimal

  • Supraorbital

  • Posterior Ethmoidal

  • Anterior Ethmoidal

  • Medial Palpebral

  • Frontal

  • Dorsal Nasal


Carotid artery anatomy15
Carotid Artery Anatomy

Occular group

  • Central artery of the Retina

  • Short Posterior Ciliary

  • Long Posterior Ciliary

  • Anterior Ciliary

  • Muscular


Carotid artery anatomy16
Carotid Artery Anatomy

Terminal Branches of the ICA

  • Anterior Cerebral

  • Middle Cerebral

  • Posterior Communicating


Carotid artery anatomy17
Carotid Artery Anatomy

Anterior Cerebral (ACA)

  • Arises from the ICA at the medial extremity of the lateral cerebra fissure

  • Passes forward and medialward across the anterior perforated substance

  • Passes above the optic nerve to the commencement of the longitudinal fissure


Carotid artery anatomy18
Carotid Artery Anatomy

Anterior Cerebral

  • Here it comes into close relationship with the opposite artery

  • Connected ti the opposite artery by a short trunk, the anterior communicating artery (ACoA)


Carotid artery anatomy19
Carotid Artery Anatomy

Middle Cerebral (MCA)

  • Largest branch of the ICA

  • Runs first lateralward in the lateral cerebral fissure

  • The it runs backward and upward on the surface of the insula


Carotid artery anatomy20
Carotid Artery Anatomy

Posterior Communicating Artery

  • Runs backward form the ICA

  • Anastomoses with the Posterior Cerebral Artery (PCA) a branch of the Basilar Artery.


Carotid artery anatomy21
Carotid Artery Anatomy

Anterior Choroidal

  • Arises from the ICA, near the PCoA

  • Passes backward and lateralward between the temporal lobe and the cerebral peduncle

  • Enters the inferior horn of the lateral ventricle through the choroidal fissure ends in the choroid plexus


Carotid artery anatomy22
Carotid Artery Anatomy

ECA

  • Begins at the level of the upper border of the thyroid cartiage.

  • Runs posterosuperiorly to the region between the neck of the mandible and the lobule of the auricle

  • Terminates by dividing into two terminal branches, the Internal Maxillary and Superficial Temporal arteries.


Carotid artery anatomy23
Carotid Artery Anatomy

Branches of the ECA

  • Anterior Branches

    • Superior Thyroid

    • Lingual

    • Facial (External Maxillary)

  • Ascending Branch

    • Ascending Pharyngeal


Carotid artery anatomy24
Carotid Artery Anatomy

Branches of the ECA

  • Posterior Branches

    • Occipital

    • Posterior Auricular

  • Terminal Branches

    • Superficial Temporal

    • Internal Maxillary


Vertebral artery anatomy
Vertebral Artery Anatomy

Vertebral Artery

  • First branch of the Subclavian

  • Arises from the upper and back of the first part of the Subclavian Artery

  • Ascends in foramina in the transverse processes of the upper six cervical vertebrae


Vertebral artery anatomy1
Vertebral Artery Anatomy

Vertebral Artery

  • Winds behind the superior articulating surface of the atlas

  • Enters the skull through the foramen magnum

  • Unites at the lower border of the pons with the artery of the opposite side to form the Basilar artery


Vertebral artery anatomy2
Vertebral Artery Anatomy

Vertebral Artery

  • Divided into 4 segments

    • V1 - Segment from the origin of the verterbral artery to its entrance into the foramen of the transverse process

    • V2 – Segment of the vertebral artery that courses cranially through the foramina of the transverse processes


Vertebral artery anatomy3
Vertebral Artery Anatomy

Vertebral Artery

  • V3 – Segment that extends from the artery’s exit at the axis to its entrance into the spinal canal

  • V4 – Segment from point of perforation of the dura to the origin of the basilar artery



Vertebral artery anatomy4
Vertebral Artery Anatomy

Basilar Artery

  • Formed by the junction of the two vertebral arteries.

  • Extends from lower to upper border of the pons, lying in its median groove.

  • Ends by dividing into the two Posterior Cerebral arteries.


Vertebral artery anatomy5
Vertebral Artery Anatomy

Basilar Artery Branches

  • Pontine

  • Internal Auditory

  • Anterior Inferior Cerebellar

  • Superior Cerebellar

  • Posterior Cerebral


Carotid artery anatomy25
Carotid Artery Anatomy

Circle of Willis

  • Anterior Circulation

    • ICA

    • MCA

    • ACA

    • ACoA

    • PCoA

  • Posterior Circulation

    • Vertebral Artery

    • Basilar

    • PCA


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