Isolated anomalous origin of the vertebral artery from the common carotid artery

Case report: Right vertebral and carotid artery anomalies with an aberrant right subclavian artery in two patients

Abnormal origins of the vertebral artery with supra-aortic vessel variants are exceedingly uncommon. Herein, we present two cases of the vertebral artery originating from the right common carotid artery associated with the right subclavian artery arising separately as the initial branch of the aortic arch, followed by the right common carotid artery. We reviewed the embryology of the anomalous origins of the vertebral and subclavian arteries. These variants can significantly affect surgical planning and cause severe clinical symptoms.

Abnormal origin of the vertebral arteries with Bicarotid trunk: a case report

Background

Aortic arch and vertebral artery anomalies are vascular variations that occur as a result of embryological developmental defects. Bicarotid trunk anomaly is a rare aortic arch anomaly and refers to a common single trunk origin of common carotid arteries. VA origin anomalies are mostly unilateral and the most common is the LVA originating from the aortic arch. Abnormal origin of the RVA from the RCCA is a rare vascular anomaly. In this case, we presented ARSA and bicarotid trunk anomaly with abnormal origin of the vertebral arteries.

Case presentation

A 64-year-old male was admitted to our center with complaints of chronic headache and dizziness. In addition to ARSA and bicarotid trunk anomaly, RVA originating from RCCA and LVA originating from aortic arch were observed in CT angiography. The origin of LVA was between the bicarotid trunk and LSCA. Both VA were entering the transverse foramen at the level of the C6 vertebra. These anomalies were also revealed in detail by MR angiography of head/neck.

Conclusion

Aortic arch anomalies are a group with different subtypes. Awareness of VA origin anomalies is important for planning surgical and endovascular interventional procedures.

Right Vertebral Artery Arising From Ipsilateral Common Carotid Artery With Severe Stenosis of Ostio-proximal Segment of Aberrant Right Subclavian Artery: A Rare Life-Saving Variant

Anomalous origins of vertebral arteries are rare vascular anomalies that are incidentally identified during computed tomography, magnetic resonance imaging, or digital subtraction angiograms. We present the case of a 45-year-old male who had gangrene of the right ring finger associated with absent radial, ulnar, and brachial artery pulses. A computed tomography angiogram of the upper limb including the arch of aorta showed an aberrant right subclavian artery having near-total stenosis at the origin. An anomalous origin of the right vertebral artery from the right common carotid artery was also noted. This incidental variant anomaly of the vertebral artery was vital in this case as it spared the posterior cerebral circulation from vascular insufficiency complications. It is also important for future head and neck endovascular interventions to avoid inadvertent arterial injury.

Segmental Agenesis of External Carotid Artery from Common Carotid Artery with Anomalous Reformation through Occipital Artery Anastomoses

Anomalous origin of extracranial and intracranial carotid system is subject to permutations of embryonal regression of the developing primitive embryonal vasculature. We present a case of segmental agenesis of left external carotid artery from the cervical carotid circulation. The entire left external carotid artery was supplied by the vertebral artery through muscular branches via the occipital artery. This anomaly of proximal external carotid agenesis with the entire vascular tree dependent on the posterior circulation via occipital artery muscular collaterals is unique and has not been described before. We discuss this anomaly with its embryology, clinical implications, and its relationship to a Proatlantal artery.

Right vertebral artery arising from the right common carotid artery without association with an aberrant right subclavian artery and entering the C3 transverse foramen

The right vertebral artery (VA) rarely arises from the right common carotid artery (CCA); however, the majority of anomalous right VAs are seen in combination with an aberrant right subclavian artery (SA). Independent (or isolated) right VA of the right CCA origin is extremely rare, with only a few cases reported previously. We herein report an additional case diagnosed incidentally using computed tomography angiography. This patient had a left VA arising from the aortic arch between the origins of the left CCA and left SA. The bilateral VAs took an anterior course and entered the C3 transverse foramina, at an extremely high level.

Anomalous origin of right vertebral artery from right common carotid artery

Anomalous origin of vertebral arteries is a rare vascular anomaly and mostly discovered as incidental findings during computed tomography angiogram , magnetic resonance angiography or digital subtracted angiogram of the aortic arch and cerebral vessels. Herein, we present an extremely rare case of a 31-year-old female who presented with headache after emotional trauma. A conventional cerebral angiogram showed anomalous origin of the right vertebral artery. This finding was incidentally discovered, and it is of utmost importance for future head and neck endovascular interventions to avoid inadvertent arterial injury.

Retroesophageal right subclavian artery associated with a bicarotid trunk and an ectopic origin of vertebral arteries

A rare branching pattern of the aortic arch in a female cadaver is reported. An aberrant right subclavian artery originated from the distal part of the aortic arch and following a retroesophageal course was recognized. Next to it, from the left to the right, the left subclavian artery and a short bicarotid trunk originating the left and the right common carotid artery were recognized. An unusual origin of the vertebral arteries was also identified. The left vertebral artery originated directly from the aortic arch, whereas the right vertebral artery originated directly from the right common carotid artery. Retroesophageal right subclavian artery associated with a bicarotid trunk and ectopic origin of vertebral arteries represents an exceptional and noteworthy case.

Coexistence of an aberrant right subclavian artery and anomalous origins of bilateral vertebral arteries: A case report

RATIONALE

Anatomical variations in aortic arch (AA) branching are not unusual. Generally, these variations are asymptomatic and are diagnosed incidentally. Here, we report a rare case of a middle-aged female patient with an aberrant right subclavian artery (ARSA) associated with anomalous origins of the bilateral vertebral arteries (VAs).

PATIENT CONCERNS

The patient treated for urolithiasis complained of repeated dizziness for several years.

DIAGNOSES

Echocardiography and computed tomography angiography (CTA) confirmed arterial variations. Moreover, mild stenosis was found in the left common carotid artery (LCCA), which was considered to be the cause of dizziness.

INTERVENTIONS

Congenital anomalous arteries were not necessary to intervene urgently, but aspirin and atorvastatin were administered to prevent potential thrombosis attributed to vascular stenosis after completing the operation for urolithiasis.

OUTCOMES

Whether the symptoms will be alleviated or not should be continuously followed up, and the patient may accept interventional therapy in the future if necessary.

LESSONS

Here, we report the rare variation of AA branches and highlight the importance of preoperative vascular assessment in surgical or interventional procedures for the affected body regions.

The right vertebral artery arising from the right common carotid artery: report of a rare case

Anomalous origins of the vertebral arteries are uncommon and generally associated with other abnormalities of the supra-aortic vessels. We present an extremely rare case where the right vertebral artery is arising from the right common carotid artery, with an absent brachiocephalic trunk, and the right common carotid artery as the first branch of the aortic arch followed by right subclavian artery, without any other abnormalities of the supra-aortic vessels. This vessel variation can affect endovascular procedures, surgical interventions and cause some unexpected clinical symptoms.

Anomalous Origin of the Right Vertebral Artery from the Right Common Carotid Artery

The anomalous origin of the right vertebral artery (VA) from the right common carotid artery (CCA) is a rare vascular anomaly, which is usually clinically asymptomatic and found incidentally during angiographic examinations. This anomaly is invariably associated with an aberrant right subclavian artery (RSCA). Approximately 31 cases have been reported in the literature. We present a case of a right VA originating from the right CCA in a patient with Down syndrome and discuss the imaging findings, embryological etiology of the anomaly, as well as its implications for endovascular/surgical treatment.