ArticleFrontiers in neurology2025
CTA-based risk assessment of the carotid variant of Eagle syndrome: development and internal validation of a nomogram.
Article in Frontiers in neurology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Eagle syndrome (ES) is uncommon; its carotid variant [ES-CA, sometimes termed vascular Eagle syndrome (VES)] can produce internal carotid artery (ICA) dissection or stenosis and ischemic stroke, yet is frequently underrecognized. This study leveraged large-sample computed tomography angiography (CTA) to quantify structural determinants of styloid-ICA contact and to develop and internally validate a nomogram for early risk stratification. Methods: We retrospectively included 414 consecutive head-neck CTA examinations (January 2023-March 2025). Volume rendering (VR) and maximum intensity projection (MIP) were used to delineate styloid-vessel relationships and to measure styloid process length (SPL), anterior tilt angle (FTA), and medial inclination angle (IA). Univariable/multivariable logistic regression identified correlates of ICA contact; receiver operating characteristic (ROC) analyses compared alternative SPL metrics (ipsilateral, bilateral mean, bilateral maximum) to select the optimal predictor. A nomogram incorporating significant predictors underwent 1,000-bootstrap internal validation with assessment of discrimination, calibration, and decision-curve analysis (DCA). Results: ICA contact was present in 110/414 (26.6%). Men had longer styloids and larger FTAs than women (both Conclusion: Risk of ES-CA-related ICA contact was unrelated to age or angular parameters. Styloid length and sex were the principal structural risk factors, with right-sided predominance in men and left-sided predominance in women, suggesting sex-side interaction. SPL-max was the optimal predictor, with a 3.45-mm lower cut-off in women, and the internally validated nomogram demonstrated clinical utility for early, imaging-based screening.
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