The complex anatomy of the carotid space within a small confined area is unique to the head and neck and allows for a vast array of pathology. This paper will review the anatomy of the carotid space from the skull base to the thorax, defining its borders at multiple levels, as well as its contents. The paper will also describe the myriad of mass lesions and vascular pathologies that may occur within the carotid space. The discussion will include anatomic considerations in differential diagnoses, imaging features, and lesion characteristics across multiple imaging modalities including CT, MRI, ultrasound, and conventional angiography. Entities discussed include paragangliomas, nerve sheath tumors, meningioma, fibromuscular dysplasia, carotidynia, thrombus, dissection, pseudoaneurysm, and pathology of the deep cervical chain lymph nodes. Understanding the complex and unique anatomy of the carotid space, as well as the nuances of navigating a broad differential, will empower the reader to make an accurate diagnosis.

Objective:Leber congenital amaurosis (LCA) is a rare, clinically and genetically heterogeneous disorder characterized by severe loss of vision in the first year of life, affecting approximately 3000 people in the United States. Some LCA patients manifest developmental abnormalities of the central nervous system (CNS) and neuroradiological studies have revealed a variety of cerebral anomalies in association with LCA; however, Chiari I malformations (CMI) have never been described.Case Description:We report two sisters who were referred to the pediatric neurosurgery clinic for evaluation of CMI. The elder sister presented with convergence nystagmus from 3 months of age and magnetic resonance imaging (MRI) demonstrated evidence of significant CMI. Her younger sister began developing nystagmus at 4 months of age. Both had symptomatic progression and underwent suboccipital decompression. Both were subsequently diagnosed with LCA. Case specifics and imaging findings are presented.Conclusions:CMI have been found in association with several genetic syndromes, but not with LCA. These patients represent the first reported cases of CMI with LCA and suggest an additional potential CNS anomaly. The unique occurrence in siblings and the association with another inherited disorder are suggestive of a genetic basis for CMI.

The pressure measurement was performed 10 times for each condition. Repeated measures ANOVA was conducted for statistical evaluation. Results: With the presence of PCOM, pressures (mean/ median ± SD) during suction using 8-F with and without balloonocclusion of ICA are 23.6/23.5 ± 2.72 mm Hg and 32.3/32 ± 2.21 mm Hg. 9-F catheter achieved statistically superior aspiration both with and without BO (-43.6/-50 ± 10.3 mm Hg and-13.2/-9 ± 15.9 mm Hg) to those of 8-F catheter (P<0.000001). Aspiration with BO at ICA was more efficient than without (P<<0.000001). There was significant interaction between the catheter size and effect of BO (P ¼ 0.000002). With the absent PCOM, suction using either 8-F or 9-F catheter with and without BO are more efficient than those with the presence of PCOM (8F with BO:-6.7/-5.5 ± 2.36 mm Hg, 8F without BO: 35.0/35.0 ± 1.63 mm Hg, 9F with BO:-49.3/-50 ± 1.50 mm Hg, and 9-F without BO:-33.3/-36 ± 14.2 mm Hg; 8F vs. 9F, P<<0.000001; with BO vs. without, P<<0.000001). Conclusions: Both larger catheter size and use of BO demonstrated statistically more efficient aspiration with 3D printing stroke model. Significant interaction between catheter size and BO was noted. Presence of PCOM significantly decreased the efficiency of aspiration.

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49% male, average age 60 ± 15). Collected variables included demographics, 6-month mortality, and whether documented advance care planning (ACP) had occurred within 3 months prior to the procedure. ACP type was also recorded, including code status, goals of care (GOC) discussion, living will, appointment of a surrogate decision maker, unspecified advance directive, and discussion of ACP without documentation. Chi-squared and Fisher's exact tests were used to compare use of ACP between groups. Logistic regression was used to identify demographic variables independently associated with undergoing ACP or a procedure near the end of life. Results: A large proportion of patients did not have documented ACP within 3 months prior to their IR procedures (65% of inpatients; 82% of outpatients). ACP was used more often among patients who died within 6 months after their procedure compared to those who lived longer (inpatients: 48.64% versus 31.65%, P< 0.01; outpatients: 31.33% versus 17.06%, P< 0.01). The most common forms of ACP used included clarifying code status (3.80%) and GOC discussions (6.24%) whereas living wills and POLST forms were rarely utilized (1.40%). There were also demographic disparities. For example, male gender (OR ¼ 1.45, P ¼ 0.04) and younger age (OR ¼ 0.99, P ¼ 0.01) were independently associated with undergoing ACP in the outpatient setting and people who identify as white (OR ¼ 0.32, P ¼ 0.01) or Hispanic/ Latino (OR ¼ 0.04, P ¼ 0.02) were less likely to undergo an outpatient procedure where they died within 6 months. Similarly, patients who identify as Native Hawaiian or Other Pacific Islander (OR ¼ 12.82, P ¼ 0.02) were more likely to undergo an inpatient procedure where they died within 6 months. Conclusions: ACP is underutilized in IR and inconsistently performed for certain demographics groups. Given the role of IR in caring for critically ill patients, practices should consider trialing workflows that consistently offer and document ACP for all patients to clarify goals and preferences prior to IR procedures.