Successful embolization of a fistula between the ascending pharyngeal artery and internal jugular vein.

The case of a fistula between the ascending pharyngeal artery and internal jugular vein in a patient with a high jugular bulb is presented. The lesion was missed by selective internal and external carotid angiography due to technical reasons, but was well demonstrated by common carotid and subsequent superselective ascending pharyngeal angiography. A single Gelfoam embolus soaked in Pantopaque obliterated the lesion.

Angiography of the external carotid to internal carotid anastomosis.

The EC/IC bypass is being performed more and more, and angiography is essential as part of the postoperative evaluation. This review of 41 patients points out the need for selective external carotid angiography in those cases where intracranial vessels fill spontaneously at the same time as the shunt. However, 8 of 11 cases showed the superficial temporal artery to be larger on the selective external carotid angiogram than in the common carotid study done during the same session. In two cases undergoing staged occlusive procedures as treatment for giant aneurysm, the external carotid artery leading to an EC/IC was occluded as an angiographic complication without neurologic sequelae.

Angiographic study of the growth of intracranial aneurysms.

The authors have attempted to assess whether there is any standard rate of growth of intracranial aneurysms. Angiographic studies were performed on 67 patients with 82 aneurysms with intervals between angiograms ranging from a few days to 10 years. Examination of these records showed no consistent rate of change in size, possibly partly because of inherent inaccuracies in the method, which are discussed. The clinical reasons for the repeat studies are briefly mentioned. It is concluded that it is unwise to wait and see what may happen to any but perhaps the smallest aneurysm.