Multiple anomalies in the origin and course of vertebral arteries and aberrant right subclavian artery in a child with moyamoya syndrome

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.

Imaging Challenges in the Diagnosis of Anatomical Variations of the Supra-Aortic Vessels: A Case Report and Review of Literature

A 73-year-old woman was referred to our Cardiology Department due to recurrent headaches and dizziness. She had a history of hypertension of 10 years. In the territorial hospital, left internal carotid artery significant stenosis was suspected. Neurological examination and laboratory tests were normal. A neck vascular ultrasound was performed, showing a low bifurcation of the left common carotid artery (CCA) and a hypoplastic left internal carotid artery (ICA) with a sinuous path at the cervical level. Therefore, a computed tomographic (CT) angiography examination of the head and neck vessels was performed. The images confirmed the presence of a hypoplastic left ICA, anatomic variation in the left CCA, and also showed that the left vertebral artery (VA) was stemming directly from the aortic arch, exhibiting a kinking trajectory.

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.