{
  "abstract": "Background Cervical internal carotid artery dissection (ICAD) is a major cause of ischemic stroke, particularly in younger patients, yet many cases lack a clear structural trigger. Elongation of the styloid process has been hypothesized to contribute to vascular injury through chronic mechanical interaction with the adjacent carotid artery. We evaluated whether styloid length and width differ between patients with and without ICAD in a small retrospective cohort using nonparametric analysis.Methods We performed a retrospective chart and imaging review of patients evaluated at a single tertiary stroke center. Styloid morphology was assessed on cross-sectional imaging within the electronic medical record. Two independent reviewers measured styloid length and width from the mastoid origin to the distal tip using standardized imaging tools. Interobserver variability was minimal, and averaged measurements were used for all analyses to reduce measurement bias. Patients were categorized according to the presence or absence of cervical ICAD. Given the small sample size and non-normal distribution of measurements, continuous variables are reported as medians with interquartile range (IQR; Q1-Q3). Exploratory group comparisons were performed using the Mann-Whitney U test.Results Twenty patients met inclusion criteria, including six with cervical ICAD and fourteen non-dissection controls. Median styloid length was greater among patients with ICAD compared with controls (32.5 mm [IQR 31.2-33.8] vs 24.0 mm [IQR 22.2-25.8]; exploratory Mann-Whitney U p=0.016). In contrast, median styloid width was similar between groups (4.6 mm [IQR 4.1-6.2] in ICAD vs 4.8 mm [IQR 4.3-6.0] in controls; p=0.96). Across the cohort, styloid morphology demonstrated expected anatomical variability. Traditional vascular risk factors, including hypertension, diabetes mellitus, and smoking history, were present in both groups without a clear distinguishing pattern.Conclusions In this small single-center retrospective study, patients with cervical ICAD demonstrated longer median styloid lengths compared with non-dissection controls, while styloid width did not differ appreciably. These findings support the hypothesis that elongated styloid anatomy may represent a structural contributor to carotid arterial injury, although results should be considered exploratory and hypothesis-generating given the limited sample size and retrospective design. Recognition of the styloid-carotid relationship on routine neurovascular imaging may have implications for risk stratification and future mechanistic studies. Larger prospective and multicenter investigations with standardized measurement protocols are needed to determine whether styloid elongation represents an independent risk factor for ICAD.Disclosures A. Suri: None. K. Koch: None. J. Snyder: None. F. Hui: None.",
  "authors": [
    {
      "affiliations": [
        "Medicine, University of Hawaii, Honolulu, HI",
        "Neurointerventional Surgery, The Queen’s Health System, Honolulu, HI"
      ],
      "name": "A Suri"
    },
    {
      "affiliations": [
        "Medicine, University of Hawaii, Honolulu, HI"
      ],
      "name": "K Koch"
    },
    {
      "affiliations": [
        "Medicine, University of Hawaii, Honolulu, HI"
      ],
      "name": "J Snyder"
    },
    {
      "affiliations": [
        "Medicine, The Queen’s Health System, Honolulu, HI"
      ],
      "name": "F Hui"
    }
  ],
  "title": "E-126 Styloid morphology and risk of cervical internal carotid artery dissection: a retrospective single-center imaging study",
  "uid": "b1562747-d9fa-56c5-a9e8-7d8e812d4091"
}