Vasa vasorum: another cause of the carotid string sign.
OBJECTIVE
Our purpose was to describe a variant of the carotid string sign that may be associated with a completely occluded vessel and to consider possible pathophysiological mechanisms for this observation.


METHODS
Carotid angiography was performed in three patients with suspected carotid stenosis and in a fourth with carotid dissection. Surgery was performed in one of the patients with carotid stenosis.


RESULTS
On all angiograms, instead of a single linear or curvilinear contrast "string," either single or multiple serpiginous channels were seen. In one case, such a channel was seen emanating from below the origin of an occluded internal carotid stump, reconstituting the distal portion of the vessel. Surgery revealed a completely occluded lumen with a small intramural vessel bypassing the obstruction.


CONCLUSIONS
We propose that these channels are either atherosclerotically induced neovessels connecting bridging vasa vasorum or recanalized luminal thrombus. We review the literature associated with this subject.
Martin
M A
MA
Department of Neuroradiology, Vancouver General Hospital, BC, Canada.
Marotta
T R
TR
D000368:Aged; D000783:Aneurysm / Q000000981:diagnostic imaging; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging; D016893:Carotid Stenosis / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014651:Vasa Vasorum / Q000000981:diagnostic imaging*