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Anatomical features of the occipital artery on CTA and differences between patients with/without stenosis and occlusion of the internal carotid artery

  • Authors:
    • Tengfei Luan
    • Jinlu Yu
  • View Affiliations

  • Published online on: December 29, 2021     https://doi.org/10.3892/mi.2021.28
  • Article Number: 3
  • Copyright: © Luan et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

The understanding of the basic anatomy of the occipital artery (OA) is crucial, and computed tomography angiography is an effective tool for this purpose. In the present study, a comparison between healthy subjects and patients with internal carotid artery (ICA) stenosis and occlusion was made. The following parameters were measured: Age, sex, diameters and lengths of the OA in different locations, distance from the edge of the foramen magnum to the OA and the distance from the midline to the OA at the level of the superior nuchal line. A total of 205 participants who met the inclusion criteria were selected for further investigation. In addition, 50 healthy subjects (100 sides, left and/or right) were selected as the control group. A total of 155 patients (180 sides, left and/or right) were selected as the stenosis and occlusion groups, including the mild and moderate ICA stenosis group (50 sides, left and/or right), severe ICA stenosis group (80 sides, left and/or right) and the ICA occlusion group (50 sides, left and right). General information, measured parameters and statistical analysis results are provided for these groups. No significant differences were observed in the anatomical parameters of the OA among these groups. Thus, in addition to providing anatomical data, the present study demonstrates that stenosis and the occlusion of the ICA do not significantly alter the anatomy of the OA.

Introduction

The occipital artery (OA) is a main artery that originates from the external carotid artery (ECA) and may be involved in a number of diseases, such as moyamoya disease, dural arteriovenous fistula (DAVF), aneurysm, etc. (1). Apart from its involvement in these diseases, the OA is a crucial artery due to its main anatomical variations and its usage in intra- and extracranial bypasses; therefore, the understanding of the anatomy of the OA is of utmost importance (2).

Previous studies on the OA have been mostly based on cadavers and catheter-based angiography procedures (3-5). Studies using computed tomography angiography (CTA) are rarely reported (6,7). Therefore, the present study was performed to examine the anatomy of the OA using CTA. Importantly, the data of the present study were derived from Han Chinese subjects, a population cohort that has rarely been reported in such cases.

In addition to providing OA parameters, most importantly, in the present study, the OA anatomy was compared between healthy subjects and patients with internal carotid artery (ICA) stenosis and occlusion to determine whether the OA parameters differed. This was performed as the OA can become dilated or thicker than normal in the presence of a DAVF (1). To date, no study has explored this issue, at least to the best of our knowledge.

Materials and methods

Study participants

An imaging study was performed on Han Chinese candidates, including healthy subjects and patients with ICA stenosis and occlusion, who underwent cervical CTA examinations between January, 2020 and September, 2021 at the First Hospital of Jilin University, Changchun, China. The healthy subjects underwent a cervical CTA examination during routine physical examinations.

Prior to the CTA, the following exclusion criteria were used: A history of severe or anaphylactic reaction to iodinated contrast, an inability to cooperate with scanning protocols, hemodynamic instability, diabetes, the administration of any anticoagulant medication, renal impairment.

The present study was approved by the Ethics Committee of the First Hospital of Jilin University (approval no. 2021-533). Written informed consent was obtained from all participants. The original CTA data were further processed on a GE Workstation (version 4.7) (GE Healthcare; Cytiva).

CTA imaging protocol

CTA examinations were performed on 256-multidetector CT scanners (GE Healthcare; Cytiva) at the First Hospital of Jilin University, utilizing THE test bolus injection technique to acquire the optimal trigger time (8). The scanned area ranged from the aortic arch to the frontal sinus. On the basis of the body weight of the patient, a dose of 2 ml/kg of nonionic iodinated contrast media (Omnipaque 350; GE Healthcare; Cytiva) and 20-30 ml saline chaser were injected via an antecubital vein through an 18-gauge peripheral intravenous line at a flow rate of 4 to 5 ml/sec using a MedRad Mark V power injector (MedRad, Inc.) (9).

Inclusion criteria and grouping

First, contrast-enhanced imaging upon CTA of the participants was clear, and the ECA and OA could be clearly seen and measured. For the healthy subjects, no ECA or ICA abnormities were observed. For patients with ICA stenosis and occlusion, the history of ICA stenosis and occlusion was chronic and progressive due to arteriosclerosis; in these patients, the ECA was normal and had no stenosis at the origin. No tumor or vascular diseases, such as scalp or intramuscular hemangioma (10,11), arteriovenous malformation (12), or DAVF (13), were associated with the OA.

Accordingly, the patients were divided into a mild and moderate ICA stenosis (ICA stenosis <70%) group, a severe ICA stenosis (ICA stenosis 70-99%) group and an ICA occlusion group (Fig. 1) (14).

Software and tools used for post-processing

The raw CTA data were post-processed using the GE Workstation (version 4.7; GE Healthcare; Cytiva). The raw CTA data were primarily reconstructed using volume rendering. Structures that affected the measurements were removed using the cutting tool. The diameter of the vessel and the distances between structures were obtained using the ‘measure distance’ tool. The curved length of a vessel was measured using the two-click AVA tool, and the curved three-dimensional length could be measured accurately. All the parameters were measured three times, and the average value was used for analysis.

Measured parameters Vessel diameter

The vessel diameters included the ECA diameter at the OA origin, the OA diameter at its origin, the OA diameter at the superior nuchal line, the OA diameter 2 cm above the superior nuchal line and the OA diameter at the midline of the foramen magnum. When measuring the OA diameter at the superior nuchal line and OA diameter 2 cm above the superior nuchal line, if the OA was branched, the thickest portion of the main trunk was measured.

Curve length of the vessel. The curve lengths included the lengths of the OA from its origin to the superior nuchal line, between the superior nuchal line and 2 cm above the superior nuchal line, and from the midline level of the foramen magnum to the superior nuchal line. When measuring these parameters, if the OA was branched, the thickest portion of the main trunk was measured.

Spatial distance. The spatial distances included the distance from the edge of the foramen magnum to the OA and the distance from the midline to the OA at the level of the superior nuchal line. For the distance from the midline to the OA at the level of the superior nuchal line, if the OA was branched, the thickest portion of the main trunk was measured. All measured parameters are illustrated in Fig. 2.

OA variations

A number of variations were recorded, including the common origin with other ECA branches arising from the ICA and OA-vertebral artery anastomosis (Fig. 3).

Statistical analysis

Statistical assessments were performed using GraphPad Prism (version 8.02) software (GraphPad Software, Inc.). Continuous variables are expressed as the mean ± standard deviation. A paired t-test was used for the comparison of two continuous variables. Ordinary one-way ANOVA followed by Tukey's multiple comparisons test was used for the comparison of multiple continuous variables. The Chi-squared test was used to compare count data among multiple groups. A P-value <0.05 was considered to indicate a statistically significant difference.

Results

General information

A total of 205 Han Chinese participants who met the inclusion criteria were selected for further investigation. A total of 50 healthy subjects (100 sides, left and/or right) were selected as the control group. In total, 155 patients (180 sides) were selected as the stenosis and occlusion groups, including the mild and moderate ICA stenosis group (50 sides, left and/or right), severe ICA stenosis group (80 sides, left and/or right) and ICA occlusion group (50 sides, left and/or right).

In the control group (50 subjects), the average age was 60.14±11.56 years (range, 33-88 years), and the ratio of males to females was 1.94:1 (33/17). In the mild and moderate ICA stenosis group (38 patients), the average age was 64.26±9.38 years (range, 37-80), and the ratio of males to females was 2.8:1 (28/10). In the severe ICA stenosis group (71 patients), the average age was 64.73±8.31 years (range, 33-79 years), and the ratio of males to females was 1.54:1 (43/28). In the ICA occlusion group (46 patients), the average age was 62.04±9.361 years (range, 41-80 years), and the ratio of males to females was 1.54:1 (30/16). The age and sex data, and their comparisons are summarized in Table I, Table II and Table III.

Table I

Age data of the study participants.

Table I

Age data of the study participants.

GroupRange (years)Mean (years)P-valuea
Control (50 subjects)33-8860.14±11.560.0527
Mild and moderate ICA stenosis (38 subjects)37-8064.26±9.38 
Severe ICA stenosis (71 subjects)33-7964.73±8.31 
ICA occlusion (46 subjects)41-8062.04±9.36 

[i] aThe data were analyzed using ordinary one-way ANOVA; due to the P-value >0.05, one-way ANOVA indicated that the degree of ICA stenosis had no significant effect on patient age. The P-values from multiple comparisons between groups are presented in Table III. ICA, internal carotid artery.

Table II

Sex data of the study participants.

Table II

Sex data of the study participants.

GroupMale (no. of participants)Female (no. of participants)P-valuea
Control (50 subjects)33170.5947
Mild and moderate ICA stenosis (38 subjects)2810 
Severe ICA stenosis (71 subjects)4328 
ICA occlusion (46 subjects)3016 

[i] aData were analyzed using the Chi-squared test; due to the P-value >0.05, the Chi-squared test indicated that the degree of ICA stenosis had no significant effect on the sex of patients. P-values of all the comparisons made are presented in Table III. ICA, internal carotid artery.

Table III

Multiple comparisons of the age and sex data in Tables I and II.

Table III

Multiple comparisons of the age and sex data in Tables I and II.

 P-value
Comparison between groupsAgeSex
Control vs. mild and moderate ICA stenosis0.19420.4388
Control vs. severe ICA stenosis group0.05050.5423
Control vs. ICA occlusion group0.76720.9357
Mild and moderate ICA stenosis vs. severe ICA stenosis group0.99500.1707
Mild and moderate ICA stenosis vs. ICA occlusion group0.71840.4035
Severe ICA stenosis group vs. ICA occlusion group0.45300.6117

[i] For age data, Tukey's multiple comparisons test was used. For sex data, the Chi-squared test was used. ICA, internal carotid artery.

It should be noted that for the participants, their weight, height and body mass index should be included. However, as some data were from the out-patient department, these data could not be provided.

Measured parameters

Among the healthy subjects, the ECA diameter at the OA origin was 4.37±0.93 mm (range, 2.5-8.7 mm). The OA diameter at its origin was 1.94±0.33 mm (range, 1.3-2.8 mm). The length of the OA from its origin to the superior nuchal line was 142.2±19.39 mm (range, 104.9-185.9 mm). The OA diameter at the superior nuchal line was 1.68±0.35 mm (range, 0.8-3.0 mm). The OA diameter 2 cm above the superior nuchal line was 1.14±0.39 mm (range, 0.4-2.3 mm). The length of the OA between the superior nuchal line and 2 cm above the superior nuchal line was 39.34±9.1 mm (range, 22.6-71.2 mm). The OA diameter at the midline of the foramen magnum was 2.07±0.39 mm (range, 1.5-3.1 mm). The distance from the edge of the foramen magnum to the OA was 29.88±3.47 mm (range, 24.1-42.1 mm). The length of the OA from the midline level of the foramen magnum to the superior nuchal line was 89.82±14.89 mm (range, 56.9-129.5 mm). The distance from the midline to the OA at the level of the superior nuchal line was 36.09±4.42 mm (range, 25.6-48.7 mm). The overall data and their comparisons are summarized in detail in Tables IV and V.

Table IV

Measured parameters in the different groups.

Table IV

Measured parameters in the different groups.

No.ParameterGroupsRange (mm)Mean (mm) P-valuea
1ECA diameter at the OA originControl2.5-8.74.37±0.930.0888
  Mild and moderate stenosis3.0-5.94.14±0.61 
  Severe stenosis2.9-5.74.09±0.66 
  Occlusion2.1-64.3±0.86 
2OA diameter at its originControl1.3-2.81.94±0.330.1260
  Mild and moderate stenosis1.3-2.51.89±0.26 
  Severe stenosis0.8-2.82.02±0.34 
  Occlusion1.4-3.12.0±0.31 
3Length of the OA from its origin to the superior nuchal lineControl104.9-185.9142.2±19.390.1467
  Mild and moderate stenosis97-211.1147.1±22.3 
  Severe stenosis89.8-198.6143.1±22.15 
  Occlusion109.1-200.3149.6±19.92 
4OA diameter at the superior nuchal lineControl0.8-31.68±0.350.5392
  Mild and moderate stenosis0.7-2.31.59±0.39 
  Severe stenosis0.7-2.71.63±0.45 
  Occlusion0.9-2.71.68±0.41 
5OA diameter 2 cm above the superior nuchal lineControl0.4-2.31.14±0.390.6269
  Mild and moderate stenosis0.4-2.21.07±0.45 
  Severe stenosis0.4-2.01.08±0.38 
  Occlusion0.5-2.21.06±0.39 
6Length of the OA between the superior nuchal line and 2 cm above the superior nuchal lineControl22.6-71.239.34±9.100.0782
  Mild and moderate stenosis23.9-64.136.71±7.74 
  Severe stenosis20.4-61.136.25±8.55 
  Occlusion22.4-59.136.83±7.93 
7OA diameter at the midline of the foramen magnumControl1.5-3.12.07±0.390.3562
  Mild and moderate stenosis1.5-2.81.97±0.24 
  Severe stenosis1.4-3.42.04±0.37 
  Occlusion1.4-2.82.08±0.36 
8Distance from the edge of the foramen magnum to the OAControl24.1-42.129.88±3.470.8757
  Mild and moderate stenosis24.6-38.429.54±3.20 
  Severe stenosis24.3-36.229.72±2.64 
  Occlusion23.2-35.929.49±2.98 
9Length of the OA from the midline level of the foramen magnum to the superior nuchal lineControl56.9-129.589.82±14.890.8427
  Mild and moderate stenosis54.9-129.992.25±15.56 
  Severe stenosis41.3-153.591.08±19.36 
  Occlusion51.4-136.791.44±15.33 
10Distance from the midline to the OA at the level of the superior nuchal lineControl25.6-48.736.09±4.420.0723
  Mild and moderate stenosis27.7-45.235.96±4.16 
  Severe stenosis19.3-48.337.75±5.15 
  Occlusion26.1-45.536.34±4.72 

[i] In the table, the control group included 100 sides (left and/or right), the mild and moderate ICA stenosis group included 50 sides (left and/or right), the severe ICA stenosis group included 80 sides (left and/or right), and the ICA occlusion group included 50 sides (left and/or right).

[ii] aThe data were analyzed using ordinary one-way ANOVA; due to the P-value >0.05, one-way ANOVA indicated that the degree of ICA stenosis had no significant effect on these parameters. The P-values from multiple comparisons between groups are presented in Table V. CA, external carotid artery; ICA, internal carotid artery; OA, occipital artery.

Table V

Multiple comparisons of the parameters in the different groups shown in Table IV.

Table V

Multiple comparisons of the parameters in the different groups shown in Table IV.

 P-value
No.ParameterControl vs. mild and moderate ICA stenosisControl vs. severe ICA stenosis groupControl vs. ICA occlusion groupMild and moderate ICA stenosis vs. severe ICA stenosis groupMild and moderate ICA stenosis vs. ICA occlusion groupSevere ICA stenosis group vs. ICA occlusion group
1ECA diameter at the OA origin0.34970.09060.96370.98390.73880.4445
2OA diameter at its origin0.80240.42400.69870.14380.31350.9959
3Length of the OA from its origin to the superior nuchal line0.52810.99150.16560.71330.92620.3013
4OA diameter at the superior nuchal line0.55710.8511>0.99990.93580.66830.9078
5OA diameter 2 cm above the superior nuchal line0.75060.78210.69970.99810.99980.9940
6Length of the OA between the superior nuchal line and 2 cm above the superio nuchal line0.29060.08110.33400.99050.99990.9809
7OA diameter at the midline of the foramen magnum0.34760.93600.99970.68640.42620.9374
8Distance from the edge of the foramen magnum to the OA0.92230.98770.89100.98740.99990.9760
9Length of the OA from the midline level of the foramen magnum to the superior nuchal line0.83010.95620.94160.97960.99480.9994
10Distance from the midline to the OA at the level of the superior nuchal line0.99850.09280.99090.14760.97840.3350

[i] Tukey's multiple comparisons test was used to analyze the data. ECA, external carotid artery; ICA, internal carotid artery; OA, occipital artery.

OA variations

A common origin of the OA and the ascending pharyngeal artery was found on 15.4% of sides (43/280). A common origin of the OA and the posterior auricular artery was observed on 3.6% of sides (10/280). The OA-vertebral artery was found in 2.1% of sides (6/280). The OA arising from the ICA was not observed.

Results of the statistical analysis

There were no significant differences in age, sex, or anatomical parameters of the OA among the control, mild and moderate ICA stenosis group, severe ICA stenosis group and ICA occlusion groups (P>0.05) (Table I, Table II, Table III, Table IV and Table V). In the control group, no significant difference in anatomical parameters between the left and right sides was observed (Table VI).

Table VI

Measured parameters in the control group.

Table VI

Measured parameters in the control group.

No.ParameterSideRange (mm)Mean (mm)P-value
1ECA diameter at the OA originL2.8-8.74.35±0.970.8079
  R2.5-7.44.38±0.89 
2OA diameter at its originL1.4-2.81.93±0.340.5843
  R1.3-2.61.95±0.32 
3Length of the OA from its origin to the superior nuchal lineL106.9-185.9143.6±18.060.3137
  R104.9-178.5140.8±20.73 
4OA diameter at the superior nuchal lineL0.8-3.01.69±0.370.7572
  R0.9-2.51.67±0.33 
5OA diameter 2 cm above the superior nuchal lineL0.5-2.31.16±0.380.3075
  R0.4-2.21.12±0.40 
6Length of the OA between the superior nuchal line and 2 cm above the superior nuchal lineL22.6-64.440.09±9.320.4840
  R22.8-71.238.62±8.91 
7OA diameter at the midline of the foramen magnumL1.5-3.02.06±0.380.8261
  R1.6-3.12.08±0.40 
8Distance from the edge of the foramen magnum to the OAL24.1-42.130.29±3.690.1594
  R24.7-40.029.46±3.22 
9Length of the OA from the midline level of the foramen magnum to the superior nuchal lineL56.9-126.589.28±16.210.5473
  R65.0-129.590.36±13.59 
10Distance from the midline to the OA at the level of the superior nuchal lineL27.6-4736.78±4.240.0957
  R25.6-48.735.44±4.54 

[i] In the table, the control group included 100 sides (50 left sides and right sides). Data were analyzed using a paired t-test. L, left; R, right; ECA, external carotid artery; ICA, internal carotid artery; OA, occipital artery.

Discussion

The OA is a crucial structure (1), and is often be used as a donor graft for cerebral revascularization (15). This vessel may also be involved in high-flow arteriovenous shunts, functioning as an accomplice, such as in cases of DAVF where the OA is dilated and hyperplastic (Fig. 4) (1). In cases of stenosis and occlusion of the ICA, the blood flow through the ECA is entirely from the common carotid artery (16). In these cases, it is unclear whether the OA becomes thicker or longer. If the OA becomes thicker or longer, performing a bypass between the suboccipital segment of the OA and intracranial artery may help treat brain hypoperfusion.

In the present study, CTA data were collected from a control group with a normal ICA and patients with stenosis and occlusion of the ICA. The analysis of the OA diameter did not reveal any differences among the different locations and OA lengths among all groups, indicating that the redistribution of blood flow due to severe stenosis or occlusion of the ICA was insufficient in changing the anatomic characteristics of the OA. In addition, these OA data are valuable, as there are no previous studies that have provided CTA data on the OA in Han Chinese population, at least to the best of our knowledge.

The OA is a large artery that has been reported to provide a mean blood flow of 15 to 80 ml/min when used for posterior fossa bypass (17). In a previous microanatomical study by Alvernia et al (18), the outer diameter of the OA at the origin varied from 2.2-2.9 mm.

In the present study, in healthy subjects, the OA diameter at its origin was 1.94 mm, which is smaller than that in the study by Alvernia et al (18); this may be due to the fact that the OA diameter in the present study was the inner diameter. Additionally, in the present study, in healthy subjects, the ECA diameter at the OA origin was measured to be 4.37 mm, which is much larger than that of the OA. An inner diameter of 1.94 mm is sufficient for endovascular treatment through the OA, easily allowing double 0.017' microcatheters to pass through (19).

The OA branches from the ECA; in rare cases, the OA can arise from the ICA (20). In the present study, the latter was not found, perhaps due to the small sample size. However, a common trunk of the OA with other branches of the ECA or OA anastomosis with the vertebral artery were found; a common origin with the ascending pharyngeal artery was observed in 15.4% of sides, and a common origin with the posterior auricular artery in 3.6% of sides. In the study by Hayashi et al (21), the incidence of the origin of the ascending pharyngeal artery from the OA was 19%, which was similar to that presented herein. These variations are important; for instance, during endovascular treatment via the OA, care must be taken to avoid damaging the ascending pharyngeal artery and posterior auricular artery. The OA-vertebral artery anastomosis was in 2.1% of sides in the present study. Anastomosis is important, and when the ICA or vertebral artery is occluded, the OA can serve as an important path of collateral circulation.

After leaving the ECA, the OA then runs in the occipital groove of the temporal bone, medial to the digastric groove (Fig. 5) (22). The digastric groove is an important landmark; a number of studies have measured the diameter of the OA at the level of the digastric groove. For instance, in a previous microanatomical study by Matsuo et al (3), the diameter of the OA at the level of the digastric groove was 2.1 mm. In another microanatomical study by Kawashima et al (23), the diameter of the OA was 2.05 mm at its exit from the digastric groove. The present study measured the OA diameter at the midline of the foramen magnum, which corresponds to the digastric groove; the diameter in healthy subjects was 2.07 mm; thus the results of the present study were similar to those of the previous aforementioned studies. Furthermore, the distance from the edge of the foramen magnum to the OA was measured, which was 29.88 mm, providing the spatial position of the OA at the level.

For a bypass between the OA and intracranial artery, the OA should be dissected from its distal end, and the dissection should extend to the level of the mastoid process after the digastric groove (4). In a previous microsurgical study by Kawashima et al (23), the mean length of the OA from the exit of the digastric groove to the level of the superior nuchal line was 81.9 mm. In the present study, the length in the healthy subjects was 89.82 mm. This difference may be derived from the fact that the study by Kawashima et al (23) was a microsurgical study, and the dissection could not reach the digastric groove; however, the present study used CTA, avoiding muscle disturbances. Nossek et al (24) recommend that a total length of 10-12 cm be dissected to reach the anastomosis site to avoid any tension in the region of the anastomotic sutures. In the present study, the length of the OA between the superior nuchal line and 2 cm above the superior nuchal line in healthy subjects was 39.34 mm, and the total length from the digastric groove was 12.92 cm (89.82 plus 39.34 mm), which was a sufficient length.

The OA crossed upwards over the superior nuchal line; however, its diameter did not decrease significantly at this point. In the study by Kawashima et al (23), the mean diameter of the OA was 2.01 mm at the level of the superior nuchal line. In the present study, this value in healthy subjects was 1.68 mm, which is smaller than that in the aforementioned study. The reason for this difference may be that the parameter measured for the peripheral OA on CTA was the inner diameter, which is expected to be smaller than the values obtained in microanatomical studies. In addition, due to the poor filling of peripheral vessels, the measured parameters were not accurate (25).

For surgical purposes, it is important to consider that the diameter of the main trunk of the OA remains >1.0 mm. In the study by Alvernia et al (18), the diameter of the OA was still >1.0 mm at 50 mm above the superior nuchal line. In the present study, ot was found that this measurement became inaccurate 20 mm above the superior nuchal line o CTA; thus, the OA diameter at this point was measured only in healthy subjects and a value of 1.14 mm was obtained. For an OA bypass, an accurate understanding of the orientation is crucial, and previous studies have demonstrated that the OA travels 3.0-4.5 cm on the superior nuchal line lateral to the inion (3,4). In the present study, this parameter in healthy subjects was measured to be 36.09 mm, in agreement with the aforementioned studies (3,4).

In conclusion, the presents study reported data on the OA diameter in Han Chinese patients. In addition, it was demonstrated that the stenosis and occlusion of the ICA did not significantly alter the anatomy of the OA.

Acknowledgements

Not applicable.

Funding

Funding: No funding was received.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Authors' contributions

JY designed the study and drafted the manuscript. TL collected the data. TL and JY confirm the authenticity of all the raw data. JY and TL revised the manuscript. Both authors have read and approved the final manuscript.

Ethics approval and consent to participate

The present study was approved by the Ethics Committee of the First Hospital of Jilin University (Approval no. 2021-533). Written informed consent was obtained from the participants.

Patient consent for publication

The participants or their parents/guardians provided consent and agreed to have their data (shown in the figures) published.

Competing interests

The authors declare that they have no competing interests.

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Spandidos Publications style
Luan T and Luan T: Anatomical features of the occipital artery on CTA and differences between patients with/without stenosis and occlusion of the internal carotid artery. Med Int 2: 3, 2022
APA
Luan, T., & Luan, T. (2022). Anatomical features of the occipital artery on CTA and differences between patients with/without stenosis and occlusion of the internal carotid artery. Medicine International, 2, 3. https://doi.org/10.3892/mi.2021.28
MLA
Luan, T., Yu, J."Anatomical features of the occipital artery on CTA and differences between patients with/without stenosis and occlusion of the internal carotid artery". Medicine International 2.1 (2022): 3.
Chicago
Luan, T., Yu, J."Anatomical features of the occipital artery on CTA and differences between patients with/without stenosis and occlusion of the internal carotid artery". Medicine International 2, no. 1 (2022): 3. https://doi.org/10.3892/mi.2021.28