Pathophysiology of carotid-cavernous fistulas in vascular Ehlers-Danlos syndrome: a retrospective cohort and comprehensive review

Abstract

[...]the study of ICA maximum wall shear stress shows a 50% higher stress in the female bifurcation compared with the male bifurcation [77]. Only 20.5% of males have their peak curvature located within the CS, in comparison with as much as 45.1% of females. [...]we hypothesize that anatomical differences account for an irregular blood-flow pattern—which in turn accounts for the alteration of the arterial wall—due to higher shear forces in female intracranial ICA, and lead to more ICA ruptures and fistulas in female vEDS patients. [...]evidence regarding lower IMT in healthy females compared to males can be found in the literature [80–82]: sex is significantly correlated with carotid artery IMT (P 0.001), as females have significantly lower IMT than age matched males [82]. [...]due to the rarity of vEDS, there is no available evidence in the literature regarding IMT differences between male and female vEDS patients. [...]as carotid IMT is measured on the extracranial part of the carotid artery 1 cm beneath the bifurcation, the IMT profile of proximal ICA might not be translatable into structural fragility of the cavernous ICA.