{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:34:20Z","timestamp":1760060060801,"version":"build-2065373602"},"reference-count":110,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T00:00:00Z","timestamp":1754265600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>A healthy vasculature with well-regulated perfusion and pulsatility is essential for the brain. One vascular structure that has received little attention is the carotid siphon. The proximal portion of the siphon is stiff due to the narrow location in the skull base, whilst the distal portion is highly flexible. This flexible part in combination with the specific curves lead to lower pulsatility at the cost of energy deposition in the arterial wall. This deposited energy contributes to damage and calcification. Severe siphon calcification stiffens the distal part of the siphon, leading to less damping of the pulsatility. Increased blood flow pulsatility is a possible cause of stroke and cognitive disorders. In this review, based on comprehensive multimodality imaging, we first describe the anatomy and physiology of the carotid siphon. Subsequently, we review the in vivo imaging data, which indeed suggest that the siphon attenuates pulsatility. Finally, the data as available in the literature are shown to provide convincing evidence that severe siphon calcifications and the calcification pattern are linked to incident stroke and dementia. Interventional studies are required to test whether this association is causal and how an assessment of pulsatility and the siphon calcification pattern can improve personalized medicine, working to prevent and treat brain disease.<\/jats:p>","DOI":"10.3390\/jpm15080356","type":"journal-article","created":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T15:30:06Z","timestamp":1754321406000},"page":"356","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Carotid Siphon as a Pulsatility Modulator for Brain Protection: Role of Arterial Calcification Formation"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4840-6854","authenticated-orcid":false,"given":"Pim A.","family":"de Jong","sequence":"first","affiliation":[{"name":"Department of Radiology, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Bos","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands"},{"name":"Department of Radiology and Nuclear Medicine, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands"},{"name":"Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02138, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0938-6232","authenticated-orcid":false,"given":"Huiberdina L.","family":"Koek","sequence":"additional","affiliation":[{"name":"Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5476-547X","authenticated-orcid":false,"given":"Pieter T.","family":"Deckers","sequence":"additional","affiliation":[{"name":"Department of Radiology, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8196-3949","authenticated-orcid":false,"given":"Netanja I.","family":"Harlianto","sequence":"additional","affiliation":[{"name":"Department of Radiology, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5396-2989","authenticated-orcid":false,"given":"Ynte M.","family":"Ruigrok","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2493-6407","authenticated-orcid":false,"given":"Wilko","family":"Spiering","sequence":"additional","affiliation":[{"name":"Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaco","family":"Zwanenburg","sequence":"additional","affiliation":[{"name":"Center for Image Sciences, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4391-0904","authenticated-orcid":false,"given":"Willem P.Th.M.","family":"Mali","sequence":"additional","affiliation":[{"name":"Department of Radiology, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1007\/s00276-012-1042-8","article-title":"Geometric classification of the carotid siphon: Association between geometry and stenoses","volume":"35","author":"Zhang","year":"2013","journal-title":"Surg. 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