Hey Kathryn,
That’s my friend as well. ;-)
I really loved your story as well. Thanks for sharing. What a great turn of events!
Bill
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Kathryn Busch
Sent: Wednesday, May 25, 2016 11:52 PM
To: [log in to unmask]
Subject: Fwd: FW: ICA branches
Here's one sent from my friend Virginia Makeham. Her computer wouldn't let her send this!
---------- Forwarded message ----------
From: Virginia Makeham <[log in to unmask]>
Date: Thu, May 26, 2016 at 1:16 PM
Subject: FW: ICA branches
To: "[log in to unmask]" <[log in to unmask]>
Dear Kath,
Flownet rejected me when I tried to send email
Found it yesterday. They are out there everywhere !!!
Ginny
From: Virginia Makeham
Sent: Thursday, 26 May 2016 1:07 PM
To: [log in to unmask]
Subject: RE: ICA branches
Dear Flownetters,
Found this one yesterday, arising 2.55cm from the ICA origin. Confirmed on transverse plane.
Regards,
Virginia Makeham
Royal Prince Alfred Hospital
Sydney
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Kathryn Busch
Sent: Thursday, 26 May 2016 7:22 AM
To: [log in to unmask]
Subject: Re: ICA branches
How interesting, it is so good hearing your stories! I too have scanned a patient with a similar story! I scanned a patient with a distal extracranial greater than 80% ICA stenosis with a branch just proximal to it appearing to recanlise it. The surgeon thought my findings were preposterous and when he operated he ate humble pie. His registrar told me I was correct the professor never confessed himself!
Years later, the same, elderly professor asked me to scan his carotids and you wouldn't believe my fortune! He had a very prominent ICA branch near the vessel origin. I remarked and he could not deny what I saw! That is why I began the study. I swapped institutions and lost some of my meaty vascular work eg EVARs, and decided to embark on a new project ie ICA branches. I have written the paper but have had it sitting there for about a year without publishing it. I will get onto it!
The branches are small and hard to follow for any distance distally as the resolution drops off. I haven't got my computer in front of me but they are 1-2mm.
I love this flownet! It is so interesting! It's great having a forum of vascular folk. We are so isolated and few in number on Australia.
Have a great day!
Regards,
Kathryn
On May 25, 2016, at 7:54 AM, Bill Schroedter <[log in to unmask]> wrote:Wow thanks Kathryn. You always were the one for detail – I like it! Perhaps the CTA study I referenced was not as far off as I suspected.
Interestingly, the last 2 patients with ICA branches I have come across had it bilaterally. Have you been measuring the size of these branches? Wondering how large they typically are? However, I now fear you have added a few minutes to my exams that I will now spend looking more carefully. How much am I missing? Can you tell us if you have any cases where it impacted the patient clinically?
A short story - 20 years ago, I came across a patient with an ICA origin occlusion that was reconstituted approximately 1 centimeter distally via a branch. No the easiest patient to scan but there was no doubt. The patient was symptomatic and went on to angiography which of course showed ICA occlusion in spite of me telling them make sure to get good late films. I re-scanned the patient – still patent but no one would believe me. But this experience started me on the road to my belief that US is undoubtedly The Gold Standard.
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Kathryn Busch
Sent: Tuesday, May 24, 2016 7:37 PM
To: [log in to unmask]
Subject: Re: Finding
Hi!
I care! I have a paper "ïn press" at the moment of 400 patients and have found an incidence of 4% of patients, 2 of which had bilateral ICA branches.
Best Regards,
Kathryn
On Wed, May 25, 2016 at 2:05 AM, Bill Schroedter <[log in to unmask]> wrote:
Not all that may people in the world probably care but I know there are several on this list who do. Found a lady this morning with bilateral ICA branches. And yes, I identified long and transverse.
<image001.jpg>
Quite rare – told her she was not one in a million (she was a little disappointed) but….. I had not looked at the literature for a few years and have generally quoted 1 in a 1000 but turns out, it may be substantially higher than that.
http://www.ncbi.nlm.nih.gov/pubmed/24368597
They found a 0.49 % prevalence of the occipital artery origin and a 6.25 % prevalence of the superior pharyngeal branch of the ascending pharyngeal artery. Wow!
Happy Scanning!
Bill
William B Schroedter, BS, RVT, RPhS, FSVU
4120 Woodmere Park Blvd
Suite 8B
Venice, Florida 34293
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Sydney & South Western Sydney Local Health Districts regularly monitor email and attachments to ensure compliance with the NSW Ministry of Health's Electronic Messaging Policy.
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