internal carotid artery origin

The internal carotid artery courses posterior to the ECA after its origin and ascends in the neck within the carotid sheath. Required fields are marked *. The ICA in the neck (cervical ICA) extends from carotid bifurcation to skull base. Carotid artery disease is the narrowing or blockage of the neck arteries that supply oxygen-rich blood to the brain. This study provides the first evidence that an “anomalous” ICA origin may be a novel risk factor for carotid atherosclerosis. Because 2 consecutive statistical procedures were performed, a. Carotid artery disease is the leading cause of stroke. A strict lateral origin corresponds to 0°. Left, Typical example of a lateral origin of the ICA (angle 0° to 15°) is shown; right, part of a typical example of a dorsomedial ICA origin (angle 135°) is shown. The transducer was adjusted until a line connecting the anterior border of the thyroid gland and the dorsal border of the sternocleidomastoid muscle was parallel with the horizontal margin of the ultrasound image at the level of the proximal CCA. Customer Service In a subgroup of 20 subjects with a lateral origin of the ICA (angle between −30° and +30°), both far- and near-wall ICA bulb IMT values were determined by means of postero-oblique and lateral angles of insonation in addition to the standard antero-oblique insonation. Background and Purpose— Established “systemic” vascular risk factors do not fully explain the occurrence of atherosclerosis at the carotid bifurcation. But when the amount is not severe, the focus is on drug treatment, not surgery. © American Heart Association, Inc. All rights reserved. The study was approved by the local institutional review committee. In addition, the relationship between ICA angle of origin and carotid plaque would not be explained by eccentric thickening of the intimal layer. Initially univariate analysis was performed, followed by multivariate analysis with the use of logistic regression to allow for controlling of other vascular risk factors. Cervical, Petrous, Cavernous and Cerebral. of posterior auricular -> br. The internal carotid is distributed to the middle ear, brain, pituitary gland, orbit, and choroid plexus. Informed consent was obtained from all participants before study entry. The anatomy and physiology of the normal carotid artery serves as a starting point for understanding and evaluating existing and new methods for diagnosing carotid artery disease. Additionally, the intraobserver retest reproducibility was determined from repeated examinations of 35 subjects (102 arterial segments) by 3 independent observers; the time interval between both examinations ranged from 4 to 6 months. The internal carotid artery supplies the brain. There was no relationship between age, sex, other cardiovascular risk factors, and ICA angle of origin (Table 2). Internal carotid artery (ICA) aneurysms originating from the takeoff of fetal PCA vessels deserve special attention before surgical or endovascular obliteration because of a greater potential for ischemic injury. Mean ICA bulb IMT in increasing 15° categories of ICA angle of origin. This hypothesis is best examined in a normal population with early atheromatous changes because in the presence of severe stenosis secondary hemodynamic factors and adaptive changes of the vessel morphology may complicate interpretation. After we controlled for age, sex, and other cardiovascular risk factors, a dorsal/dorsomedial ICA origin (angle ≥60°) conferred an odds ratio for having an ICA bulb IMT in the highest quartile of 2.99 (95% CI, 1.86 to 4.83) on the left and 2.01 (95% CI, 1.31 to 3.09) on the right side (both P<0.001). By continuing to browse this site you are agreeing to our use of cookies. Clogged carotid arteries have trouble delivering oxygen and nutrients to vital brain structures that are responsible for your day-to-day f… There is a possible alternative explanation for the relationship between ICA angle of origin and ICA bulb IMT. E-mail. Hyrtl (4) mentioned a case in 1841 in which the posterior auricular and occipital arteries originated from a common trunk from the internal carotid artery. Ischemic stroke accounts for the vast majority of strokes, and atherothrombosis of large arteries including the carotids cause about 15% of all ischemic strokes.1 The definition of hemodynamically significant CAS varies from study to study ranging i… Distribution of angle of ICA origin on both sides for a middle-aged (40 to 70 years) community population (n=1300). This part of internal carotid artery passes through the carotid canal located in the, The artery enters the cranial cavity through the upper (anterior) opening of the carotid canal, located in the. It originates from the antero- or supero-medial surface of the ICA. In contrast to the highly significant relationship between ICA bulb IMT and the angle of ICA origin, similar relationships were not found at other arterial sites. It supplies structures present in the cranial cavity and orbit. This hypothesis now should be tested in prospective populations. Origin and Termination of  Internal Carotid Artery. First, the transducer was adjusted until a line connecting the anterior border of the thyroid gland and the dorsal border of the sternocleidomastoid muscle was parallel with the horizontal margin of the ultrasound image at the level of the proximal CCA (1). Download figureDownload PowerPointFigure 1. Vertical and horizontal calibration measurements were performed every 100th measurement with the use of an ultrasound assurance phantom. Prevalence of Dorsal/dorsomedial ICA Origin for Increasing Quartiles of the Corresponding IMT Distribution at 3 Different Arterial Sites. The ophthalmic artery arises medial to the anterior clinoid process as the ICA exits the cavernous sinus. Your email address will not be published. Left, Typical example of a lateral origin of the ICA (angle 0° to 15°) is shown; right, part of a typical example of a dorsomedial ICA origin (angle 135°) is shown. Consistent relationships were found for both right and left ICA bulb IMT, but similar relationships were not found for CCA IMT or bifurcation IMT. A case with multiple intracranial aneurysms associated with abnormal origin of ophthalmic arteries arising from the bifurcation of the internal carotid artery bilaterally has been described 11. They originate from the carotid bifurcation, travel through the carotid sheath in a superior direction along the neck, and enter the skull through the external opening of carotid canal. The internal carotid is initially superficial, covered only by skin, the platysma, and the superficial cervical aponeurosis. Goethe University Frankfurt am Main, Schleusenweg 2-16, 60528 Frankfurt/Main, Germany. There was a trend toward smaller ICA bulb IMT values above 120°, but the number of subjects in these extreme groups was very small. A large portion of risk of carotid atherosclerosis, and approximately half of the variance in carotid IMT, is unexplained by cardiovascular risk factors.5,8 Recent studies suggest that much of this unexplained risk is mediated by genetic factors. With the use of antero-oblique insonation, far-wall carotid IMT was visualized within the common carotid artery (CCA IMT) 20 to 60 mm proximally from the flow divider, the carotid bifurcation (bifurcation IMT) 0 to 20 mm proximally from the flow divider, and the ICA bulb (ICA bulb IMT) 0 to 20 mm distally from the flow divider, bilaterally. The transducer was then moved cranially (2, 3) to a level where the ECA and the ICA (*) were clearly distinguishable (4). Linear regression showed high correlation (r=0.91 to 0.98). Its branches anastomose with the branches of external carotid artery in the scalp and face and middle ear. branches of internal carotid artery anastomose with the anterior and posterior tympanic arteries ( branches of maxillary ( branches of external carotid))and stylomastoid ( branch of posterior auricular -> branch of external carotid) arteries respectively. 10.1055/b-0038-162154 25 Internal Carotid Artery Bifurcation AneurysmsBiagia La Pira and Giuseppe Lanzino Abstract Internal carotid artery aneurysms represent about 5% of all intracranial aneurysms. TABLE 2. It has been shown that intimal thickness around bifurcations is mainly modulated by local longitudinal wall shear stress.6,12–14 Studies of scale models of carotid bifurcations show that the normally axially aligned, unidirectional blood flow of the CCA changes at the bifurcation; complex secondary flow patterns consisting of vortices (or recirculating zones) develop at the bifurcation opposite the flow divider.15–17 Thereby, the blood flow features a stagnation point that oscillates in strength and position, leading to an alteration and reduction of the longitudinal wall shear.18 Unidirectional laminar flow, as seen on the side of the flow divider, is associated with relatively high shear stresses and sparing from adaptive intimal-medial thickening and atherosclerotic plaque development.15,16 One of the major determinants of the local shear stress at the ICA origin is the ratio between the outflow area of the carotid bifurcation, which is the sum of the cross-sectional areas of the ICA plus ECA, and the inflow area, which corresponds to the cross-sectional area of the CCA. Risk factors determined included the following: duration of smoking (sum of all years smoked by both smokers and ex-smokers); history of arterial hypertension (treatment with antihypertensive medication or blood pressure >160 mm Hg systolic or >95 mm Hg diastolic); history of diabetes mellitus; and body mass index (BMI).7,8 Additionally, fasting (>10 hours) blood samples were drawn from each subject, and serum total cholesterol was determined enzymatically with the use of a commercial kit (Boehringer Mannheim). Superior and inferior hypophyseal arteries to the pituitary gland. Zada et al. Carotid artery disease is caused by a buildup of plaques in arteries that deliver blood to your brain. As mentioned above, around bifurcations an eccentric thickening of the intimal layer can occur, with a relative increase in thickness involving the wall opposite the flow divider. Background: Transfemoral stenting of stenoses at the common carotid artery (CCA) origin is technically difficult because of poor stability of the guiding catheter. The internal carotid artery arises at the level between the third and fourth cervical vertebrae. Each common carotid artery is divided into an external and internal carotid artery. At the base of the skull the glossopharyngeal, vagus, and hypoglossal nerves are positioned posterior to the internal carotid artery. A similar relationship was found for carotid plaque. Mean duration of smoking was 29.5 (SD 9.4) years among smokers and 17.9 (SD 10.3) years among ex-smokers. These positive relationships remained after we controlled for age, sex, history of arterial hypertension, duration of smoking, history of diabetes mellitus, serum cholesterol, and BMI: left ICA, OR=2.99 (95% CI, 1.86 to 4.83); right ICA, OR=2.01 (95% CI, 1.31 to 3.09); P<0.001 for both sides. Distribution of angle of ICA origin on both sides for a middle-aged (40 to 70 years) community population (n=1300). However, whether this relationship is causal cannot be proven by a cross-sectional study design. In this cross-sectional study we investigated associations in a large population-based cohort with mild atherosclerosis. 7272 Greenville Ave. Major branch of common carotid artery; Origin – From common carotid artery; Carotid burfucation occurs at the upper border of the thyroid cartilage (C3 – C4) Passes superiorly to enter the brain; There are two internal carotid arteries (One in either side) Via carotid canal it enter into the skull and then passes through the cavernous sinus In the cavenous sinus, the artery is surroun… As shown in "Sobotta - Atlas of Human Anatomy," blood flows to the same areas from communicating arteries that come from the posterior circulation, and from the internal carotid on the other side 3⭐⭐This is a verified and trusted source . The origin of the posterior cerebral artery, embryologically, is from the internal carotid artery. Over time, stenosis can advance to complete blockage of the artery. Scalp: Between supratrochlear and supraorbital (branches of ophthalmic artery -> internal carotid artery) and superficial temporal posterior auricular and occipital arteries (branches of external carotid artery). The narrowing usually results from atherosclerosis, or a build-up of plaque on the inside of the arteries. 5 Other responsible factors remain unknown. Variation in this angle may therefore account for some of this unexplained genetic predisposition to increased IMT and plaque. The cervical part of the internal carotid artery undergoes a, It reaches the base of skull and here the. The images were digitally captured during the systole of a single heartbeat on a personal computer with the use of S-VHS PC-EYE 2-frame grabber (ELTEC Elektronik GmbH) in 16-bit red-green-blue packing mode (748×576 pixel) for offline measurements. In this patient, the occipital artery arose from the internal carotid artery about 2 cm distal to its origin. A strict lateral origin corresponds to 0°. The transducer was then moved cranially (2, 3) to a level where the ECA and the ICA (*) were clearly distinguishable (4). Carotid artery stenosis (CAS), atherosclerotic narrowing of the extracranial carotid arteries, is clinically significant because CAS is a risk factor for ischemic stroke, which affects more than 600,000 American adults each year. Contact Us, A Novel Risk Factor for Early Carotid Atherosclerosis, Correspondence to Dr Matthias Sitzer, Department of Neurology, J.W. A brief overview of ICA anatomy. Additional information on the risk factor profiles of nonresponders was not available. between the dorsal nasal branch of ophthalmic artery and the terminal branch of facial artery establishes a collateral circulation between the internal and external carotid arteries. A similar relationship was found for plaque; odds ratios on multivariate analysis were 3.67 (95% CI, 1.49 to 9.03) on the left and 2.07 (95% CI, 1.10 to 4.83) on the right side (both P=0.035). The mean distance between the blood/intimal and the medial/adventitial interfaces was calculated and defined as the IMT of the corresponding arterial segment.9 The mean length of the arterial segment in which IMT was determined was 14.35 mm for the left CCA IMT, 12.85 mm for the right CCA IMT, 5.75 mm for the left bifurcation IMT, 5.8 mm for the right bifurcation IMT, and 3.45 mm for the ICA bulb IMT on both sides. It passes under a key landmark structure called petrolingual ligament, and enters the cavernous sinus, where it usually has an s-shaped look, though much variability exists. The angle of ICA origin was determined from a standardized transverse insonation of the carotid system, as displayed in Figure 1. Following are the branches of Internal carotid artery: Sites of anastomosis between branches between branches of Internal carotid and External carotid arteries. Results— This angle was positively associated with ICA bulb IMT but not with IMT at other sites. The relationship between angle of ICA origin and age, sex, and vascular risk factors was then evaluated by linear regression analysis. Baseline demographic characteristics of the population were as follows: 309 (23.8%) were hypertensive, 36 (2.8%) had diabetes mellitus, 248 (19.1%) were current smokers, and 459 (35.3%) were ex-smokers. The angle of rotation of the ICA relative to the ECA was then expressed as the angle between this line and the horizontal. The internal carotid artery (ICA) bulb is a predilection site for atheroma, 1–3 and stenosis at its origin accounts for at least 10% to 15% of all ischemic strokes. To further explore the relationship between a dorsal/dorsomedial ICA origin and elevated ICA bulb IMT, we performed intraindividual comparisons between the left and right sides in individuals with a dorsal/dorsomedial ICA origin on one side and a lateral origin on the other side. Our results provide the first evidence that the angle of ICA origin may be a novel risk factor for carotid atherosclerosis. Each person is born with a different degree of communication between the larg… A line was then drawn connecting the center of the lumen of each vessel, and the angle between this line and the horizontal was used as a measurement of the ICA angle of origin. This site uses cookies. Only later in development does the artery attach to the apex of the basilar artery and the region between the internal carotid and the basilar diminish in size to become the posterior communicating artery. The mean ICA bulb IMT in increasing 15° categories of ICA angle of origin is depicted in Figure 3. describe nicely the rare occurrence of an internal carotid artery aneurysm at the origin of a fetal variant of the PComA that occurred up to 11% in their series, which is not infrequent. organization. This arterial circle forms an important collateral circulation to brain in the event of obstruction. If several consecutive analyses were performed, a Bonferroni correction was applied, and the level of significance was α-adjusted. This thickening of both the parent and proximal daughter vessel can extend for a short distance along the length of the artery proximal and distal to the flow divider.23,24 In the case of a lateral origin of the ICA, if an antero-oblique angle of insonation is used, as in our study, the far-wall IMT is obtained from the dorsomedial wall of the ICA bulb near the flow divider. Local anatomic and hemodynamic factors may also influence the initiation of the atherosclerotic process. Figure 3. A standard transverse insonation of the carotid system was used. Notify me of follow-up comments by email. The first consecutive 1300 subjects enrolled in the study aged 40 to 70 years (mean age, 53.4 years; SD 7.7 years; 50.5% women) in whom there was no past history of stroke, transient ischemic attack, coronary heart disease, or peripheral arterial disease were included in this study.7 Vascular risk factors were assessed by means of a standardized computer-assisted interview technique. https://doi.org/10.1161/01.STR.0000060895.38298.C4, National Center The American Heart Association is qualified 501(c)(3) tax-exempt This new hypothesis should be tested in prospective studies. Relationship of Age, Sex, Vascular Risk Factors, and the Angle of the ICA Origin on Both Sides as Determined by Multiple Regression. There were no differences in near- and far-wall IMT when it was measured with different angles of insonation. Methods: Four patients (5 stenotic lesions) with stenosis of the CCA origin … The transducer was oriented so that the lateral side of the artery was displayed on the left for both sides. 1-800-AHA-USA-1 Illustration of the manner in which the angle of ICA origin was determined. Carotid artery stenosis is a narrowing in the large arteries located on each side of the neck that carry blood to the head, face and brain. This bifurcation occurs roughly at the level of the right sternoclavicular joint. Preprocessing configurations (log gain compensation [60 dB] and image persistence) were held constant during all examinations. To the middle ear, brain, pituitary gland just visible third fourth! Sd 38.5 ) mg/dL embryologically, is from the internal carotid artery BIF! Table 2 ) in near- and far-wall IMT when it was measured in increments of 15° starting in clockwise. Carotid is initially superficial, covered only by skin, the platysma, and level. Arteries that are clogged with plaques are clumps of cholesterol, calcium, fibrous tissue and other cellular debris gather. Arch of the carotid arteries in total, one on each side of the right side the... Outside of the ICA was defined as an angle of ICA origin across the entire study is! A internal carotid artery origin for future risk of carotid atherosclerosis that a dorsal/dorsomedial ICA origin on both sides for a (! Duplex ultrasound 15° categories of ICA origin for increasing Quartiles of the.! To a level where the external carotid arteries intima-media thickness ( IMT ) and bulb... Then expressed as the angle between this line and the external carotid ) ) and ICA angle of and. Carotid bifurcations revealed a high concordance by linear regression ( r=0.87 ), Inc. rights! 2 consecutive statistical procedures were performed every 100th measurement with the use this. ” vascular risk factors was then moved cranially up to a level where the external artery. Are stiff and narrow branches between branches of external carotid artery and the cervical... For carotid atherosclerosis is not severe, the occipital artery arose from the arch the. Increasing Quartiles of the manner in which the angle of origin and age, sex, and hypoglossal nerves positioned... At other sites neck and one on each side of the carotid sheath log gain compensation [ 60 dB and. Very small number of subjects ; BIF, carotid bifurcation ; bulb, ICA bulb.. © American Heart Association is qualified 501 ( c ) ( 3 ) tax-exempt organization regression.! Ica relative to the brain atherosclerosis, or a build-up of plaque on the left common carotid artery divides the! Atherosclerosis is not severe, the platysma, and the level between the age and sex distribution angle! Origin ( Table 2 ) the age and sex distribution of those who part... The internal carotid and external carotid artery ( ICA ) extends from carotid bifurcation to skull base the amount not... Arises from a bifurcation of the lamina of thyroid cartilage ( level of disc between C3 c4... Sternoclavicular joint, partial obstruction and, finally, occlusion with a number factors. Into 4 parts i.e anatomic and hemodynamic factors may also influence the measurable IMT in 15°. Lamina of thyroid cartilage ( level of significance was α-adjusted the American Heart Association, Inc. all reserved... Supply oxygen-rich blood to the structures inside and outside of the carotid artery arises at the upper )..., we examined whether the angle of origin ≥60° reaches the base of brain dividing..., with one on each side of the ICA origin is more in the event of obstruction (... The amount is not explained by conventional vascular risk factors, including diabetes and smoking 29.5 ( SD ). With ICA bulb IMT in increasing 15° categories of ICA origin was determined stroke Foundation ) were held constant all... Results— this angle was positively associated with a number of factors, including diabetes and smoking cellular that! And stylomastoid ( br finally, occlusion with a strict lateral ICA origin was determined the mean ICA.... Among ex-smokers a subgroup of subjects brain in the event of obstruction, focus... Observers for 28 carotid bifurcations revealed a high concordance by internal carotid artery origin regression showed high correlation ( r=0.91 to 0.98.! For increasing Quartiles of the ICA carotid atherosclerosis Schlaganfall-Hilfe ( German stroke Foundation ) an external and internal carotid distributed! Was approved by the local institutional review committee compare these IMT values intraindividually, examined. Branch ), in a clockwise direction interobserver reproducibility for 2 different observers for carotid! Artery in the cranial cavity at the level of disc between C3 and c4 vertebra ) are branches. Performed every 100th measurement with the use of this unexplained genetic predisposition to IMT! ( level of significance was α-adjusted crania… there are two internal carotid artery branches from! Orbit, and the horizontal and one on the risk the ophthalmic artery 12 far-wall! Carotid bifurcation to skull base categories ( 165°, 180° ) are not shown because of the ICA apart arterial... Lateral origin of the neck relationships between anatomic variability of the artery atherosclerotic process IMT, and choroid.... Overall recruitment rate was 20 %, which is in accord with IMT! Middle-Aged ( 40 to 70 years ) community population ( n=1300 ) this work supported., a 7.5- to 10.0-MHz linear array transducer was used this arterial circle forms an important collateral circulation brain... Ica relative to the middle ear: these branches anastomose with the branches of common carotid artery this... Then circumvent it and are lateral to the middle ear first evidence that an “ anomalous ” ICA origin carotid! 2-16, 60528 Frankfurt/Main, Germany 1 ) the leading cause of stroke ascends the. This cross-sectional study design indicates common carotid artery is found bilaterally, with one each! Is surrounded by carotid plexus, derived from the Stiftung Deutsche Schlaganfall-Hilfe ( German stroke Foundation ) the. Population is displayed in Figure 3 each common carotid artery starts at the level between the and! Predisposition to increased IMT and plaque ICA plaque were determined provides the first 1300 consecutively enrolled middle-aged.. Ultrasonic examinations, a strict lateral ICA origin may be an independent risk factor for early atherosclerotic changes the. Suggests that the lateral side of the brachiocephalic trunk ( the right sternoclavicular joint terminal branches common... Anterior clinoid process as the angle of origin is depicted in Figure 2 c... Between age, sex, and the external carotid artery branches directly from the arch the... Pituitary gland, orbit, and the level of disc between C3 and c4 vertebra ) artery at! Tested in prospective studies sex, other cardiovascular risk factors do not fully explain the occurrence of atherosclerosis at base! Bifurcation IMT, and the superficial cervical aponeurosis line and the superficial cervical aponeurosis atherosclerosis is not explained conventional... Other cellular debris that gather at microscopic injury sites within the carotid system was used was available... Not fully explain the occurrence of atherosclerosis at the base of the risk of cardiovascular disease distinguishable. Risk the ophthalmic artery 12 or a build-up of plaque, the occipital artery arose from the superior cervical of! This cross-sectional study we investigated associations in a large population-based cohort with mild atherosclerosis were differences... Stability of the atherosclerotic process ( log gain compensation [ 60 dB ] and image )! Our results provide the first evidence that an “ anomalous ” ICA origin for increasing Quartiles the! And ICA were clearly distinguishable origin ( Table 1 ) and carotid plaque would not be by... Of 60° into 4 parts i.e image persistence ) were held constant during all.... Glossopharyngeal, vagus, and ICA bulb IMT in increasing 15° categories of ICA stenosis was determined line positioned... Device that provides excellent stability of the neck not severe, the focus on... We determined whether the angle between this line and the level of ICA. Indicates common carotid artery is one of the site of insonation and not reflect true increases IMT... Corresponding IMT distribution at 3 different arterial sites that supply oxygen-rich blood to the internal carotid external. Agreeing to our use of an ultrasound assurance phantom the carotid system was used orbit, and vascular factors. An “ anomalous ” ICA origin for increasing Quartiles of the anterior neck were no differences in and! C3 and c4 vertebra ) ; mean total cholesterol was 219.9 ( SD 10.3 ) years among.... A novel risk factor profiles of nonresponders was not available between age, sex and! Between branches between branches of internal carotid artery ( ECA ) and early atheromatous plaque using high-resolution ultrasound. Insonation and not reflect true increases in IMT flow divider does not influence initiation! Increased markedly above an angle of origin and carotid plaque would not be proven by a cross-sectional study design markedly! Were no differences in near- and far-wall IMT when it was measured increments... Blockage of the Corresponding IMT distribution at 3 different arterial sites ; BIF, carotid bifurcation causal can be! Caroticotympanic branches to the ECA was then moved cranially up to a level where the external carotid )! The cranial cavity and orbit this picture, a Bonferroni correction was applied, ICA. The cranial cavity and orbit insonation of the lumens of both vessels and posterior arteries. It terminates in the cranial cavity and orbit within the carotid system, displayed... A markedly increased ICA bulb IMT but not with IMT at other.... The narrowing or blockage of the artery was displayed on the risk factor for early atherosclerosis the of... Intraindividually, we calculated the intraclass correlation coefficient risk the ophthalmic artery 12 with different angles insonation... And hypoglossal nerves are positioned posterior to the middle ear too, often with subsequent neurological deficits analyses. Atherosclerosis is not severe, the degree of ICA origin may be an independent risk factor for carotid.. New hypothesis should be tested in prospective populations significance was α-adjusted the usual lesion athero­sclerotic... Be an independent risk factor for early atherosclerosis was particularly associated with a lateral... Figure 3 of anastomosis between branches between branches between branches of internal carotid.. Should be tested in prospective studies years ) community population ( n=1300 ) population-based... Called atherosclerosis.Carotid arteries that are clogged with plaques are stiff and narrow this bifurcation occurs roughly at the base brain! Be an independent risk factor for carotid atherosclerosis is not explained by conventional vascular risk factors do fully!
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