Carotid and Cerebral Artery Malformation: Causes, Symptoms, Treatment, Surgery, Mortality, Prognosis, and Management

Definition of Carotid and Cerebral Arterial Malformations

Carotid and cerebral arterial malformationsrefer to abnormal structural changes in blood vessels, meaning congenital or acquired vascular malformations occurring in the carotid and cerebral arteries. These malformations can disrupt blood flow or cause problems in blood vessels that play a crucial role in supplying oxygen and nutrients to the brain. Since carotid and cerebral arterial malformations are closely associated with stroke, cerebral hemorrhage, and heart disease, early detection and appropriate treatment are essential.

Typical examples of carotid and cerebral arterial malformations include carotid arteriovenous fistula(Carotid Arteriovenous Fistula), carotid aneurysm(Carotid Aneurysm), cerebral aneurysm(Cerebral Aneurysm), cerebral arteriovenous malformation (AVM), etc. All of these can cause serious complications due to abnormal vascular connections, expansion, or deformation.

Characteristics of Carotid and Cerebral Arterial Malformations

The characteristics of carotid and cerebral arterial malformations vary depending on the type of malformation and the resulting changes in blood flow.

1. Carotid Arteriovenous Fistula (Carotid Arteriovenous Fistula):

• Characteristics: This is a condition where the carotid artery and surrounding veins are abnormally connected. High-pressure arterial blood flows into the low-pressure veins, putting pressure on the blood vessel walls, significantly affecting blood flow. Arteriovenous fistulas mostly occur after trauma but can also be congenital.
• Complications: This malformation can affect blood flow to the brain, causing stroke, hemorrhage, visual impairment, and headaches.

2. Carotid Aneurysm (Carotid Aneurysm):

• Characteristics: This is a condition where the carotid artery wall weakens and the blood vessel bulges. Aneurysms occur due to damage to the blood vessel wall and can grow larger over time. Rupture of an aneurysm can cause massive bleeding, making it very dangerous.
• Complications: Rupture of an aneurysm can cause serious bleeding and lead to acute cerebral hemorrhage. As an aneurysm grows, the blood vessel wall thins, increasing the risk of rupture.

3. Cerebral Aneurysm (Cerebral Aneurysm):

• Characteristics: This is a condition where the wall of a cerebral artery weakens and expands locally. This can occur in important arteries supplying blood flow to the brain, and if it grows larger, it can cause cerebral hemorrhage.
• Complications: If an aneurysm ruptures, cerebral hemorrhage occurs, which can lead to stroke, coma, and serious neurological disorders.

4. Cerebral Arteriovenous Malformation (AVM):

• Characteristics: This is a condition where the arteries and veins in the brain are abnormally connected. Normally, blood flows from the arteries through capillaries to the veins; however, in AVMs, the arteries and veins are directly connected, and high-pressure blood flows directly into the veins.
• Complications: Due to the pressure difference in the blood vessels, cerebral hemorrhage can occur, which can cause acute stroke. AVMs are mostly congenital problems, but symptoms can appear suddenly, so caution is needed.

Causes of Carotid and Cerebral Arterial Malformations

The causes of carotid and cerebral arterial malformations can be divided into congenital and acquired causes.

1. Congenital Causes:

• Genetic Factors: Carotid and cerebral arterial malformations can be caused by some genetic factors. For example, Ehlers-Danlos syndrome(Ehlers-Danlos syndrome) or Marfan syndrome(Marfan syndrome) can weaken blood vessels, leading to malformations.
• Developmental Abnormalities: During fetal development, improper blood vessel formation can lead to abnormal vascular connections. This results in congenital malformations.

2. Acquired Causes:

• Trauma: Traffic accidents, sports injuries, and other trauma can damage the carotid or cerebral arteries. This can lead to abnormal connections or weakening of the blood vessel walls, resulting in malformations.
• Atherosclerosis: Atherosclerosis, which occurs with age, thickens and weakens the blood vessel walls, which can lead to malformations. Hypertension and hyperlipidemia can also affect the blood vessel walls, causing malformations.
• Infection: If blood vessels are damaged or inflammation occurs due to infection, malformations can occur in the carotid and cerebral arteries. In particular, weakening of the blood vessel wall due to bacterial infection can cause malformations.

Symptoms of Carotid and Cerebral Arterial Malformations

Symptoms of carotid and cerebral arterial malformations vary depending on the size and location of the malformation and changes in blood flow. The main symptoms are as follows:

1. Headache: Headaches can occur if carotid and cerebral arterial malformations affect blood flow. Headaches can be persistent and severe, especially if the malformation is large.
2. Dizziness and Fainting: Dizziness or fainting can occur if the malformation affects blood flow, resulting in insufficient blood supply to the brain.
3. Visual Impairment: Visual problems can occur if carotid or cerebral artery malformations affect blood flow. Blurred vision, temporary loss of vision, etc., may occur.
4. Tinnitus: In particular, in malformations such as carotid arteriovenous fistulas, abnormal blood flow in the blood vessels can affect the ears, causing tinnitus.
5. Neurological Symptoms: If the malformation becomes severe, neurological symptoms such as paralysis, speech disorders, and memory impairment may appear due to decreased blood flow to the brain.
6. Stroke Symptoms: If a cerebral aneurysm or AVM ruptures, acute stroke symptoms may appear. In this case, paralysis of the face, arms, and legs, slurred speech, and confusion may occur.

Treatment and Surgical Methods for Carotid and Cerebral Arterial Malformations

Treatment methods for carotid and cerebral arterial malformations vary depending on the size, location, and condition of the malformation. The main treatment methods are as follows:

1. Medication:

• Anticoagulants: If there is an arteriovenous fistula or aneurysm, there is a risk of blood clot formation. Anticoagulants can be used to prevent blood clotting.
• Antihypertensive drugs: If hypertension is the cause, medications to control blood pressure are used to normalize blood vessel pressure.

2. Surgical Treatment:

• Arteriovenous Fistula Surgery: If there is an arteriovenous fistula, it can be surgically removed or the normal vascular connection can be restored. Depending on the size and location of the arteriovenous fistula, surgery is used to restore blood flow.
• Aneurysm Resection: If an aneurysm occurs in the carotid or cerebral artery, surgery is performed to remove the aneurysm and reconstruct the blood vessel. If the aneurysm grows larger, the risk of rupture increases, so prompt surgery is necessary.
• Cerebral Aneurysm Treatment: In the case of a cerebral aneurysm, surgery can be used to resect the aneurysm or insert a stent to restore blood flow. Depending on the case, endoscopic treatmentor minimally invasive procedurescan also be considered.

3. Endoscopic Treatment:

• Some carotid or cerebral arterial malformations can be treated using minimally invasive methods using endoscopes. This method helps with faster recovery and minimizes postoperative complications.

Prognosis and Management of Carotid and Cerebral Arterial Malformations

The prognosis of carotid and cerebral arterial malformations depends on the type of malformation, the time of detection, and whether treatment was received. If the malformation is large or severely affects blood flow, the prognosis may be poor; however, early diagnosis and treatmentcan improve the prognosis.

Management methods:

1. Regular Checkups: Because carotid and cerebral arterial malformations can progress, regular examinations and ultrasound, CT, MRI and other imaging tests should be used to monitor the size and condition of the malformation.
2. Lifestyle Modifications: To prevent and manage diseases that affect vascular health, such as hypertension and hyperlipidemia, it is important to practice a healthy diet, regular exercise, non-smoking, and moderate alcohol consumption.
3. Psychological Support: It is also important to receive psychological support to manage anxiety or stress caused by malformations. Counseling or rehabilitation therapy can reduce mental burden.

Early detection and appropriate treatment of carotid and cerebral arterial malformations can improve the prognosis, so it is important to visit a medical institution promptly if symptoms appear.