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Rahmatian A, Yaghoobpoor S, Tavasol A, Aghazadeh-Habashi K, Hasanabadi Z, Bidares M, Safari-kish B, Starke RM, Luther EM, Hajiesmaeili M, Sodeifian F, Fazel T, Dehghani M, Ramezan R, Zangi M, Deravi N, Goharani R, Fathi M. Clinical efficacy of endovascular treatment approach in patients with carotid cavernous fistula: A systematic review and meta-analysis. World Neurosurg X 2023; 19:100189. [DOI: 10.1016/j.wnsx.2023.100189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/18/2023] [Accepted: 03/21/2023] [Indexed: 03/31/2023] Open
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2
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Deepalam SR, Reddy Kankara S, Menezes CR, Goddu Govindappa SK. Transfacial venous embolisation of a spontaneous indirect paediatric caroticocavernous fistula. BMJ Case Rep 2023; 16:e252149. [PMID: 36609418 PMCID: PMC9827181 DOI: 10.1136/bcr-2022-252149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
We present a rare case of a spontaneous indirect caroticocavernous fistula (CCF) in an early adolescent, who exhibited a 1-month history of redness, decrease in vision and proptosis of the right eye without a history of trauma or connective tissue disorder. An MRI of the brain and orbit and a digital subtraction angiography confirmed the diagnosis of Barrow type D CCF. The same was then treated with coiling and a liquid embolising agent using the transfacial venous route, resulting in complete obliteration. Reduction in conjunctival congestion with mild improvement in visual acuity was noted postprocedure. Complete recovery was noted at the 6-month follow-up visit. CCF, though rare in the paediatric population, should be highly considered in the differential diagnosis when the above-mentioned complaints are present. Early diagnosis and intervention have favourable outcomes.
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Affiliation(s)
| | - Shreyas Reddy Kankara
- Radiodiagnosis, St John's National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Clyde Richard Menezes
- Radiodiagnosis, St John's National Academy of Health Sciences, Bangalore, Karnataka, India
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Zanaty M, Chalouhi N, Tjoumakaris SI, Hasan D, Rosenwasser RH, Jabbour P. Endovascular treatment of carotid-cavernous fistulas. Neurosurg Clin N Am 2014; 25:551-63. [PMID: 24994090 DOI: 10.1016/j.nec.2014.04.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Endovascular management has become the treatment of choice for carotid-cavernous fistulas regardless of the fistula type. The endovascular method offers numerous options that render it capable of treating each fistula type by choosing an adequate technique. This advantage along with the advancement in the field has led to fewer complications with higher success rate.
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Affiliation(s)
- Mario Zanaty
- Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, 909 Walnut Street, Philadelphia, PA 19107, USA
| | - Nohra Chalouhi
- Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, 909 Walnut Street, Philadelphia, PA 19107, USA
| | - Stavropaula I Tjoumakaris
- Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, 909 Walnut Street, Philadelphia, PA 19107, USA
| | - David Hasan
- Department of Neurosurgery, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Robert H Rosenwasser
- Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, 909 Walnut Street, Philadelphia, PA 19107, USA
| | - Pascal Jabbour
- Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, 909 Walnut Street, Philadelphia, PA 19107, USA; Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurological Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, 2nd Floor, Philadelphia, PA 19107, USA.
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Korkmazer B, Kocak B, Tureci E, Islak C, Kocer N, Kizilkilic O. Endovascular treatment of carotid cavernous sinus fistula: A systematic review. World J Radiol 2013; 5:143-155. [PMID: 23671750 PMCID: PMC3647206 DOI: 10.4329/wjr.v5.i4.143] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 02/06/2013] [Indexed: 02/06/2023] Open
Abstract
Carotid cavernous sinus fistulas are abnormal communications between the carotid system and the cavernous sinus. Several classification schemes have described carotid cavernous sinus fistulas according to etiology, hemodynamic features, or the angiographic arterial architecture. Increased pressure within the cavernous sinus appears to be the main factor in pathophysiology. The clinical features are related to size, exact location, and duration of the fistula, adequacy and route of venous drainage and the presence of arterial/venous collaterals. Noninvasive imaging (computed tomography, magnetic resonance, computed tomography angiography, magnetic resonance angiography, Doppler) is often used in the initial work-up of a possible carotid cavernous sinus fistulas. Cerebral angiography is the gold standard for the definitive diagnosis, classification, and planning of treatment for these lesions. The endovascular approach has evolved as the mainstay therapy for definitive treatment in situations including clinical emergencies. Conservative treatment, surgery and radiosurgery constitute other management options for these lesions.
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Pawar N, Ramakrishanan R, Maheshwari D, Ravindran M. Acute abducens nerve palsy as a presenting feature in carotid-cavernous fistula in a 6-year-old girl. GMS OPHTHALMOLOGY CASES 2013; 3:Doc03. [PMID: 27625935 PMCID: PMC5015603 DOI: 10.3205/oc000013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Carotid-cavernous fistulas (CCF) are abnormal communications between the internal carotid artery and the cavernous sinus. Traumatic carotid-cavernous fistulae are rare potential complications of craniofacial trauma. Typical findings of CCF are proptosis, chemosis, headache, oculomotor or abducens nerve palsy, trigeminal pain and pulsating bruit over the temporal skull and the bulb. CCF are reported very rarely in childhood. This report describes the clinical and radiological findings of a pediatric patient presented with CCF.
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Affiliation(s)
- Neelam Pawar
- Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - R Ramakrishanan
- Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Devendra Maheshwari
- Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Meenakshi Ravindran
- Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
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6
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Abstract
OPINION STATEMENT The treatment of a carotid cavernous fistula (CCF) depends on the severity of the clinical symptoms, its angiographic characteristics, and the risk it presents for intracranial hemorrhage. In most instances, endovascular treatment is preferred.High-flow direct CCFs usually are traumatic or are caused by rupture of a cavernous aneurysm into the sinus, but a small percentage can be spontaneous. They usually present with sudden development of a clinical triad: exophthalmos, bruit, and conjunctival chemosis. All direct CCFs should receive treatment, because they carry a high probability of intracranial hemorrhage or neurologic deterioration.Low-flow indirect or dural CCFs, either incidental or with minimal symptoms, are not associated with significant risk of intracranial hemorrhage. The accepted practice is to treat ocular symptoms conservatively with medical management or manual carotid compression. If the patient cannot tolerate the symptoms, or if signs of ocular morbidity occur, endovascular treatment is offered.The first treatment option should be endovascular embolization with a combination of detachable balloons, coils, stents, or liquid embolic agents. The procedure can be performed from either an arterial or venous approach. Use of these materials and techniques can yield a high cure rate with minimal complications.If the patient is not amenable to embolization or if the embolization fails, then surgery (surgical ligation of the internal carotid artery or packing of the cavernous sinus) should be offered.Stereotactic radiosurgery may be an elective treatment for low-flow CCFs, but it has no role in the treatment of high-flow CCFs.
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Abstract
A 4-month-old boy presented with the sudden onset of proptosis and dilated episcleral veins. CT revealed an enlarged superior ophthalmic vein and diffusely thickened extraocular muscles. MRI and angiography confirmed a dural middle meningeal--cavernous sinus fistula. Embolization was performed leading to successful resolution of the patient's signs and symptoms. Spontaneous atraumatic arteriovenous cavernous fistulae in infancy are extremely rare, but should be included in the differential diagnosis of infants with orbital congestion. Appropriate treatment leads to prevention of amblyopia, glaucoma, and anisometropia.
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Gemmete JJ, Ansari SA, Gandhi D. Endovascular Treatment of Carotid Cavernous Fistulas. Neuroimaging Clin N Am 2009; 19:241-55, Table of Contents. [DOI: 10.1016/j.nic.2009.01.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lawton CT, Deveikis J, Rumboldt Z, Tuite G, Cavalier M. Carotid cavernous fistula in CNS choriocarcinoma. Pediatr Blood Cancer 2008; 50:893-5. [PMID: 17366524 DOI: 10.1002/pbc.21178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Carotid artery-cavernous sinus fistulas (CCFs) are infrequently reported in the pediatric population, and are rarely reported in conjunction with CNS neoplasms. The authors present a 7-year-old girl with CNS choriocarcinoma who acutely developed left eye proptosis and conjunctival injection. Computed tomography angiography revealed a CCF, which was endovascularly embolized with detachable coils. There may be a direct cause-and-effect relationship between choriocarcinoma and development of CCFs.
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Affiliation(s)
- Cynthia Tallent Lawton
- Medical University of South Carolina School of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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Lau FHS, Yuen HKL, Rao SK, Lam DSC. Spontaneous carotid cavernous fistula in a pediatric patient: case report and review of literature. J AAPOS 2005; 9:292-4. [PMID: 15956954 DOI: 10.1016/j.jaapos.2005.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 14-year-old boy presented with spontaneous, painless proptosis of the right eye. Computed tomography and digital subtraction angiography revealed an indirect carotid cavernous fistula. Because there were no sight-threatening complications, we adopted a conservative approach. The condition resolved 1 month after initial presentation, with angiographically confirmed spontaneous obliteration of the fistula.
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Affiliation(s)
- Flora H S Lau
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon, People's Republic of China
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Weninger WJ, Müller GB. The parasellar region of human infants: cavernous sinus topography and surgical approaches. J Neurosurg 1999; 90:484-90. [PMID: 10067917 DOI: 10.3171/jns.1999.90.3.0484] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT In this study the authors analyze the peculiarities of the parasellar anatomy and the topography of surgical approaches to the parasellar region (PSR) in human infants. METHODS Forty-nine specimens of the PSR obtained at autopsy were studied using microdissection and histological analysis. Important distances between anatomical landmarks were measured with the aid of a dissecting microscope. One serially sectioned specimen was three-dimensionally reconstructed and analyzed on the computer screen by using the authors' new episcopic reconstruction technique. CONCLUSIONS The anatomy of the infant PSR differs distinctly from that of the adult. The parasellar portion of the internal carotid artery (ICA) does not form a siphon, but takes a straight course, and the venous pathways as well as the cranial and sympathetic nerves have different topographical relationships. Analyses of surgical approaches demonstrate that, in young children, the anterolateral approach can be used to reach the pterygopalatine compartment, the superior ophthalmic vein, and those pathological processes that extend from the orbit into the PSR. The approach via Parkinson's triangle can be used in 45% of cases to access the pathological processes that occur in the voluminous space above and behind the posterior flexure of the parasellar ICA. Taking this route, sympathetic nerve fibers passing through the PSR are not at risk, but some arterial branches that run within the lateral wall of the sinus can complicate this approach. This study presents a guideline that can assist radiologists and neurosurgeons in the planning and performance of interventions within the PSR of neonates and young children.
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Affiliation(s)
- W J Weninger
- Department of Anatomy, University of Vienna, Austria.
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Weninger WJ, Mülle GB. The parasellar region of human infants: cavernous sinus topography and surgical approaches. Neurosurg Focus 1999. [DOI: 10.3171/foc.1999.6.1.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
In this study the authors analyze the peculiarities of the parasellar anatomy and the topography of surgical approaches to the parasellar region (PSR) in human infants.
Methods
Forty-nine specimens of the PSR obtained at autopsy were studied using microdissection and histological analysis. Important distances between anatomical landmarks were measured with the aid of a dissecting microscope. One serially sectioned specimen was three-dimensionally reconstructed and analyzed on the computer screen by using the authors' new episcopic reconstruction technique.
The anatomy of the infant PSR differs distinctly from that of the adult. The parasellar portion of the internal carotid artery (ICA) does not form a siphon, but takes a straight course, and the venous pathways as well as the cranial and sympathetic nerves have different topographical relationships. Analyses of surgical approaches demonstrate that, in young children, the anterolateral approach can be used to reach the pterygopalatine compartment, the superior ophthalmic vein, and those pathological processes that extend from the orbit into the PSR. The approach via Parkinson's triangle can be used in 45% of cases to access the pathological processes that occur in the voluminous space above and behind the posterior flexure of the parasellar ICA. Taking this route, sympathetic nerve fibers passing through the PSR are not at risk, but some arterial branches that run within the lateral wall of the sinus can complicate this approach.
Conclusions
This study presents a guideline that can assist radiologists and neurosurgeons in the planning and performance of interventions within the PSR of neonates and young children.
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Link MJ, Coffey RJ, Nichols DA, Gorman DA. The role of radiosurgery and particulate embolization in the treatment of dural arteriovenous fistulas. J Neurosurg 1996; 84:804-9. [PMID: 8622154 DOI: 10.3171/jns.1996.84.5.0804] [Citation(s) in RCA: 104] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Over the past 5 years 29 patients with dural arteriovenous fistulas (AVFs) were treated by the authors using the Leksell radiosurgical gamma knife unit. Within 2 days after radiosurgery, 17 patients with AVFs that exhibited retrograde pial or cortical venous drainage (12 patients) and/or produced intractable bruit (eight patients) underwent particulate embolization of external carotid feeding vessels. The rationale for this treatment strategy was that radiosurgery was expected to cause obliteration of most fistulas after 12 to 36 months. In patients with bruit, ocular symptoms, or in those at risk for hemorrhage, treatment with embolization after radiosurgery kept the fistulas angiographically visible for radiosurgical targeting yet offered palliation of symptoms and temporary, partial protection from hemorrhage during the latency period. In 12 patients, preobliteration embolization immediately reduced (10 patients) or eliminated (two patients) retrograde pial venous drainage. To date, no lesion has hemorrhaged after treatment. Angiography 1 to 3 years posttreatment in 18 patients showed total obliteration of 13 fistulas (72%) and partial obliteration of five (28%). Radiosurgery, followed by embolization when retrograde pial venous drainage, intractable bruit, and/or major external carotid artery supply is present, appears to be a promising treatment for selected patients with symptomatic dural AVFs.
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Affiliation(s)
- M J Link
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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15
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Chan ST, Weeks RD. Dural arteriovenous malformation presenting as cardiac failure in a neonate. Acta Neurochir (Wien) 1988; 91:134-8. [PMID: 3407458 DOI: 10.1007/bf01424569] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Dural arteriovenous malformation (AVM) is a rare clinical entity, presenting most commonly in adult patient with pulsatile tinnitus or haemorrhage. We report a case of a neonate with a massive dural arteriovenous malformation (AVM) with signs of cardiac failure soon after birth. The diagnosis was first suggested during angiocardiography when a hypertrophied left common carotid artery was detected. The AVM was supplied by branches from the left external carotid artery and the left veretebral artery and drained into the left transverse sinus near the torcula. This was excised in two stages. Post-operative angiography showed no residual malformation. The patient was well and developing normally 4 years after surgery. Review of the literature showed only 2 similar cases of dural AVM presenting in the neonatal period, both patients died, reflecting the high risks involved and the difficulties encountered in the management. Ligation of arterial supplies can be a useful temporary procedure in these high risk babies. Definitive excision should be performed later when the baby grows stronger.
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Affiliation(s)
- S T Chan
- Department of Neurosurgery, University Hospital of Wales, Cardiff, U.K
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Viñuela F, Fox AJ, Debrun GM, Peerless SJ, Drake CG. Spontaneous carotid-cavernous fistulas: clinical, radiological, and therapeutic considerations. Experience with 20 cases. J Neurosurg 1984; 60:976-84. [PMID: 6716167 DOI: 10.3171/jns.1984.60.5.0976] [Citation(s) in RCA: 176] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Sixty-five carotid-cavernous fistulas were studied at University Hospital, London, Canada, from 1978 to 1982, 20 of which fulfilled the clinical and angiographic criteria of a spontaneous carotid-cavernous fistula. Of these 20 fistulas, 17 were unilateral, and three were bilateral. In 18 cases the angiographic findings were typical of an arteriovenous malformation (AVM), and in two a ruptured giant intracavernous aneurysm was found. These patients were treated according to whether they had a nonresolving or progressive cavernous sinus syndrome or deterioration of vision. The cavernous dural AVM's were treated with polyvinyl-alcohol and/or isobutyl-2-cyanoacrylate (IBCA) embolization of the external carotid artery blood supply. Two patients underwent postembolization surgical procedures. The detachable balloon technique was used to occlude the fistulas associated with the two giant ruptured intracavernous aneurysms and a small dural intracavernous AVM. Eight patients received no therapy; in two, spontaneous obliteration of the fistula occurred. Of the nine cavernous AVM's embolized with particles and/or IBCA, successful transvascular embolization was achieved in seven cases, and partial embolization followed by surgery in two cases. Successful balloon obliteration of the giant intracavernous ruptured aneurysm was obtained in two cases. In one patient, right hemiplegia with aphasia resulted from reflux of IBCA emboli through the artery of the foramen rotundum into the left middle cerebral artery.
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Bitoh S, Hasegawa H, Fujiwara M, Nakao K. Irradiation of spontaneous carotid-cavernous fistulas. SURGICAL NEUROLOGY 1982; 17:282-6. [PMID: 7079953 DOI: 10.1016/0090-3019(82)90123-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Two patients with spontaneous carotid-cavernous fistulas were successfully treated with cobalt 60 irradiation to the sellar region. Angiographically, one patient showed combined-type shunts comprising a dural internal carotid-cavernous fistula and a direct internal carotid-cavernous fistula; the other patient had a mixed dural external and internal carotid-cavernous fistula. The respective total radiation dose was 3,200 rads and 3,024 rads. The patients responded satisfactorily to the treatment, with disappearance of the fistulas on angiograms and patency of the internal and external carotid arteries.
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