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Ning J, Zhong G, Long X, Xie J, Ao K, Liu F, Huang M, Zhuo Y, Li Q, Wen Q, Di Q. The ambiguous "internal carotid artery"-Ultrasound diagnosis of congenital absence of the internal carotid artery: A case report and review of the literature. Medicine (Baltimore) 2023; 102:e35016. [PMID: 37682185 PMCID: PMC10489400 DOI: 10.1097/md.0000000000035016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/06/2023] [Indexed: 09/09/2023] Open
Abstract
RATIONALE Congenital anatomical variation of internal carotid artery (ICA) rarely occurs, and congenital absence of the ICA is even rarer. Few reports are available on the diagnosis of congenital absence of the ICA by carotid doppler ultrasound (CDUS), and most cases have been identified by computed tomographic angiography (CTA) or digital subtraction angiography (DSA). PATIENT CONCERNS A 61-year-old male was admitted to our hospital due to dizziness for more than half a month. He was hypertensive and had been drinking and smoking for many years. DIAGNOSES The patient was diagnosed by carotid doppler ultrasound with congenital absence of the right ICA, confirmed by CTA and DSA. A nodular aneurysm in the anterior communicating artery was observed by CTA and DSA. INTERVENTIONS After relevant preoperative examinations were performed, the patient underwent right craniotomy and clipping of the aneurysm under general anesthesia 8 days after admission. OUTCOMES The patient recovered well after surgery and no relapses has been observed. LESSONS Congenital absence of the ICA is rare and usually diagnosed by CTA or DSA in clinical practice. If radiologists do not have adequate knowledge about the associated ultrasonic characteristics, a missed diagnosis may occur. As a noninvasive and rapid screening tool for cervical vascular diseases, carotid doppler ultrasound offers a new approach for the diagnosis of congenital absence of the ICA.
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Affiliation(s)
- Jing Ning
- Department of Ultrasound, The First-Affiliated Hospital of Hunan Normal University (Hunan Provincial People’s Hospital), Changsha, China
| | - Gang Zhong
- Department of Ultrasound, The First-Affiliated Hospital of Hunan Normal University (Hunan Provincial People’s Hospital), Changsha, China
| | - Xiangdang Long
- Department of Ultrasound, The First-Affiliated Hospital of Hunan Normal University (Hunan Provincial People’s Hospital), Changsha, China
| | - Juanjuan Xie
- Department of Ultrasound, The First-Affiliated Hospital of Hunan Normal University (Hunan Provincial People’s Hospital), Changsha, China
| | - Kun Ao
- Department of Ultrasound, The First-Affiliated Hospital of Hunan Normal University (Hunan Provincial People’s Hospital), Changsha, China
| | - Fang Liu
- Department of Radiology, The First-Affiliated Hospital of Hunan Normal University (Hunan Provincial People’s Hospital), Changsha, China
| | - Mengyi Huang
- Department of Neurosurgery, The First-Affiliated Hospital of Hunan Normal University (Hunan Provincial People’s Hospital), Changsha, China
| | - Yu Zhuo
- Department of Ultrasound, The First-Affiliated Hospital of Hunan Normal University (Hunan Provincial People’s Hospital), Changsha, China
| | - Qiaorong Li
- Department of Ultrasound, The First-Affiliated Hospital of Hunan Normal University (Hunan Provincial People’s Hospital), Changsha, China
| | - Qiongli Wen
- Department of Ultrasound, The First-Affiliated Hospital of Hunan Normal University (Hunan Provincial People’s Hospital), Changsha, China
| | - Qiuyi Di
- Department of Ultrasound, The First-Affiliated Hospital of Hunan Normal University (Hunan Provincial People’s Hospital), Changsha, China
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Unilateral developmental absence of internal carotid artery with contralateral middle cerebral artery occlusion. Surg Radiol Anat 2023; 45:327-332. [PMID: 36705691 DOI: 10.1007/s00276-022-03056-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 12/02/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE Developmental absence of the internal carotid artery (ICA) is a rare congenital anomaly that results from an insult to the third aortic arch or dorsal aorta during early embryogenesis. Patients are often asymptomatic and are diagnosed incidentally during imaging to investigate neurological complaints. METHODS We report a rare finding of an absent ICA during a workup of stroke in a middle-aged patient. RESULTS CT brain perfusion (CTP) and CT angiography (CTA) revealed the right middle cerebral artery (MCA) thrombotic stroke with the demonstration of contralateral left ICA absence. The patient showed spontaneous recovery, and no thrombolysis or neurointervention was considered. CONCLUSIONS This article highlights the importance of screening the head CT on bone window settings in case of the non-visualization of ICA to differentiate congenital absence from a steno-occlusive disease. It also illustrates the role of Magnetic resonance imaging (MRI) and MR Angiography (MRA) in demonstrating further possible vascular anomalies, structural brain malformations, and collateral circulation.
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Chu YT, Hwang B, Lai YJ, Huang T, Li AH. Internal carotid artery agenesis disclosed by carotid ultrasonography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:533-535. [PMID: 36029204 DOI: 10.1002/jcu.23292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 07/02/2022] [Indexed: 06/15/2023]
Abstract
(Upper panels) Ultrasonography showed caliber difference of common carotid arteries (right side: 0.39 cm; left side: 0.70 cm) for right internal carotid artery agenesis. (Lower panels) Bilateral ophthalmic arteries showed anterograde flow with 50% flow reduction over right side (right: peak systolic velocity, PSV [23.3 cm/s]; end diastolic velocity, EDV [7.0 cm/s]; left: PSV [47.0/s] EDV [14.2 cm/s]).
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Affiliation(s)
- Yiu-Tong Chu
- Department of Neurology, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - BaoShow Hwang
- Department of Neurology, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Yen-Jun Lai
- Division of Medical Image, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Tzulun Huang
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Ai-Hsien Li
- College of Informatics, Yuan Ze University, New Taipei City, Taiwan, ROC
- Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
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Dădârlat-Pop A, Molnar A, Oprea A, Tomoaia R, Boros B, Literat S, Serban A, Manole S. Imaging Challenges in the Diagnosis of Anatomical Variations of the Supra-Aortic Vessels: A Case Report and Review of Literature. Diagnostics (Basel) 2022; 12:diagnostics12010169. [PMID: 35054336 PMCID: PMC8774562 DOI: 10.3390/diagnostics12010169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 02/01/2023] Open
Abstract
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.
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Affiliation(s)
- Alexandra Dădârlat-Pop
- Cardiology Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania; (A.D.-P.); (B.B.); (S.L.);
- Department of Cardiology, Iuliu Haţieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
| | - Adrian Molnar
- Cardiovascular Surgery Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania; (A.M.); (A.O.)
- Department of Cardiovascular Surgery, Iuliu Haţieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
| | - Alexandru Oprea
- Cardiovascular Surgery Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania; (A.M.); (A.O.)
- Department of Cardiovascular Surgery, Iuliu Haţieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
| | - Raluca Tomoaia
- Cardiology Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania; (A.D.-P.); (B.B.); (S.L.);
- Department of Cardiology, Iuliu Haţieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
- Correspondence:
| | - Bianca Boros
- Cardiology Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania; (A.D.-P.); (B.B.); (S.L.);
| | - Sorin Literat
- Cardiology Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania; (A.D.-P.); (B.B.); (S.L.);
| | - Adela Serban
- Cardiology Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania; (A.D.-P.); (B.B.); (S.L.);
- Department of Cardiology, Iuliu Haţieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
| | - Simona Manole
- Department of Radiology and Medical Imaging, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania;
- Department of Radiology and Medical Imaging, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj Napoca, 8, Victor Babes, St, 400012 Cluj-Napoca, Romania
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D'Amico A, Perillo T, Cuocolo R, Ugga L, Di Dato F, Caranci F, Iorio R. Neuroradiological findings in Alagille syndrome. Br J Radiol 2021; 95:20201241. [PMID: 34609904 PMCID: PMC8722249 DOI: 10.1259/bjr.20201241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Alagille syndrome (ALGS) is a multisystemic disease caused by mutations in genes of Notch pathway, which regulates embryonic cell differentiation and angiogenesis. Clinically, ALGS is characterized by cholestasis, cardiac defects, characteristic facial features, skeletal and ophthalmologic abnormalities. The aim of this review is to illustrate neuroradiological findings in ALGS, which are less well-known and prevalent, including cerebrovascular anomalies (such as aneurysms, dolichoectasia, Moyamoya syndrome and venous peculiarities), Chiari 1 malformation, craniosynostosis, intracranial hypertension, and vertebral anomalies (namely butterfly vertebra, hemivertebra, and craniocervical junction anomalies). Rarer cerebral midline malformations and temporal bone anomalies have also been described.
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Affiliation(s)
| | - Teresa Perillo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Renato Cuocolo
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Fabiola Di Dato
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Naples, Italy
| | - Ferdinando Caranci
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Raffaele Iorio
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Naples, Italy
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Chen J, Raden M, Lin C. Congenital absence of the internal carotid artery with intercavernous anastomosis. Radiol Case Rep 2019; 14:1021-1026. [PMID: 31210835 PMCID: PMC6562185 DOI: 10.1016/j.radcr.2019.05.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/26/2019] [Accepted: 05/27/2019] [Indexed: 11/15/2022] Open
Abstract
Congenitally absent internal carotid artery with intercavernous anastomosis is an exceedingly rare vascular anomaly. We report such a case in a 65-year-old man with chronic symptoms resembling sporadic transient ischemic attacks. While these patients are usually asymptomatic due to compensatory collateralization, they are at increased risk of aneurysm formation, and thus proper identification is important. This report serves as both a case of a very rare anomaly and as a lesson on how to avoid this misdiagnosis by carotid duplex sonography. Additionally, we review the limited number of published cases of congenitally absent internal carotid artery with intercavernous anastomosis.
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Affiliation(s)
- Jesse Chen
- Department of Radiology, Staten Island University Hospital, 475 Seaview Ave, Staten Island, NY 10305, USA
| | - Mark Raden
- Department of Radiology, Staten Island University Hospital, 475 Seaview Ave, Staten Island, NY 10305, USA
| | - Cheryl Lin
- Department of Radiology, Staten Island University Hospital, 475 Seaview Ave, Staten Island, NY 10305, USA
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Abstract
Agenesis of the internal carotid artery is a rare anomaly. It is usually asymptomatic because of the presence of anastomoses, but it can be associated with complications, especially when there is evidence of other anatomical abnormalities or severe atherosclerotic disease. We report the case of a 63-year-old female patient with hypertension and diabetes and a history of intracranial aneurysm clipping. Doppler ultrasonography and computed tomography angiography of the carotid and vertebral arteries showed unilateral agenesis of the left internal carotid artery. This report aims to highlight the importance of suspecting vascular malformations during investigation of neurological conditions. Internal carotid agenesis has a significant association with intracranial aneurysms and their early detection can spare the patient serious complications.
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