Independent origins of the internal and external carotid arteries--a case report

Absence of right common carotid artery in a patient with common origin of the innominate artery and left common carotid artery

A 50-year-old woman was referred to the noninvasive vascular laboratory for carotid artery evaluation because of a bruit in the neck. Color Doppler ultrasound examination demonstrated absence of the right common carotid artery and parallel internal and external carotid arteries originating at the brachiocephalic trunk. Computed tomography angiography further described anomalous anatomy, demonstrating a common origin of the innominate artery and left common carotid artery. Knowledge of such unusual anatomy may become valuable in future evaluation or treatment of this patient.

Congenital Aplasia of the Common Carotid Artery: A Comprehensive Review

In an attempt to describe the morphofunctional consequences of uni- and bilateral aplasia of the common carotid artery (CCA), which is usually a vascular source of the external carotid (ECA) and internal carotid (ICA) arteries, we investigated online databases of anatomical and clinical papers published from the 18th century to the present day. We found 87 recorded cases of uni- and bilateral CCA aplasia in subjects from the first hours to the eighth decade of life, which had been discovered in 14 (known) countries. Four crucial parameters were described: the embryology of the carotid arteries, morphophysiology of the carotid arteries, CCA aplasia, and unilateral versus bilateral CCA aplasia, including history, general data, diagnosing, vascular sources, caliber, course of the separated ECA and ICA, associated vascular variants, and pathological disorders. To complete the knowledge of the morphofunctional consequences of the absence of some artery of the carotid system, and risking the possibility of repeating some words, as "carotid artery", or "carotid aplasia" and the headings from our previous article about bilateral ICA absence, this review is the first in the literature that recorded all cases of the CCA aplasia published and/or cited for the past 233 years. Main characteristic of the CCA absence is its association with 21 different diseases, among which the aneurysms were in 13.69% of cases, and 17.80% of cases were without pathology.

Incidental finding of an absent left common carotid artery

We describe a case of a young woman evaluated for Raynaud's phenomenon in whom an extremely rare variation, the absence of the left common carotid artery, was incidentally detected as an isolated finding. The detection of vascular anomalies may be important for future endovascular or surgical interventions.

Absence of the right common carotid artery: a rare case without separate origins of the internal and external carotid arteries

Absence of the common carotid artery (CCA) is a rare anomaly. In the few cases described in the literature, it has been typically associated with separate origins of the internal carotid artery (ICA) and external carotid artery (ECA) Fife (1921), Boyd (1934), Rossiti and Raininko (2001), Cerase et al. (2009), Drazin et al. (2010), Yim et al. (2009), Monaco et al. (2009), Jerius et al. (1995), Dahn et al. (1999), Cakirer et al. (2002), Choi et al. (2015), Bryan et al. (1978), Horowitz et al. (2003), Roberts and Gerald (1978), Rajeshwari (2013), Purkayastha et al. (2006), Maybody et al. (2003), Wood et al. (2011) . To the best of our knowledge, absence of the CCA without separate origins of the ECA and ICA has only been described five times before, one of them in conjunction with a persistent proatlantal intersegmental artery (PIA) Cao et al. (2011) and four with agenesis of the ICA Kobayashi et al. (2013), Kunishio et al. (1987), Chen et al. (2008), Xie et al. (2010) . We present a case of a previously undescribed variation of this rare vascular anomaly.

Unique branching pattern of aortic arch in a patient with aortopulmonary window

Aortic arch (AA) anomalies are usually associated with congenital heart disease. Variations such as aberrant subclavian artery have significance if shunt surgery is planned. Other variations may be clinically insignificant or present with respiratory or oesophageal symptoms. Demonstration and understanding of arch anomalies are crucial for managing as well as improving our understanding of their embryological basis. This presentation illustrates an unusual branching pattern of AA in a patient with an aortopulmonary window in which five arteries independently arose from the AA. CT imaging appearance of the anomaly is illustrated. A brief description of the embryological basis and significance of the anomaly is presented.

Bilateral lower cervical bifurcation of the common carotid artery

Lower cervical bifurcation of cervical common carotid artery (CCA) is a very rarely encountered anatomic variation. Knowing the normal vascular anatomy and also its anomalies is important in preventing the vascular complications. Ill-defined vascular anomalies may lead to massive hemorrhage and eventually death during head and neck surgery. Imaging of the neck by magnetic resonance Imaging (MRI), CT, or angiography is helpful for diagnosis. We present a 62-year-old male patient diagnosed with laryngeal carcinoma who had been treated. His MRI revealed bilateral low-level bifurcation of the cervical common carotid arteries as well as tumor localization and its boundaries. Total laryngectomy and right selective neck dissection was performed to the patient with the diagnosis of squamous cell carcinoma of the larynx. During the neck dissection, carotid bifurcation was detected in common border of Level 3 and Level 4 of the neck.

Absent right common carotid artery with stenting of symptomatic internal carotid artery stenosis

Absent common carotid artery with independent origin of internal and external carotid arteries from the subclavian artery is a rare but recognized phenomenon. We describe one such case with an associated symptomatic proximal high-grade stenosis of the right internal carotid artery. The abnormal carotid anatomy was not initially well appreciated, resulting in a failed surgical exploration and subsequent successful endovascular carotid stenting. To our knowledge, this is the first reported case of carotid stent in a right internal carotid artery originating from the subclavian artery.

Direct percutaneous carotid artery stenting for a patient with absence of the common carotid artery

A 54-year-old man with symptomatic internal carotid artery stenosis with absence of the common carotid artery (CCA), who had been treated with surgery and postoperative radiotherapy for tonsillar carcinoma, underwent direct percutaneous carotid artery stenting (CAS). To our knowledge, this is the first report of direct percutaneous carotid artery stenting (CAS) for a patient with absent CCA.

Diagnosing common carotid artery agenesis using duplex ultrasound

The complete absence of a common carotid artery, also known as common carotid artery (CCA) agenesis, is a well-described yet extremely rare congenital anomaly. Most carotid system anomalies are related to origins of the external or internal carotid arteries. All such anomalies are typically asymptomatic unless associated with a concomitant arterial lesion that results in a workup for symptomatic intracerebral pathology or a focal neurological deficit. The literature is scant on the topic, being limited to singular case reports. We report 3 cases of CCA agenesis and provide the readers with insightful data on the available literature.

Anatomical variations of the carotid-vertebral arteries: "double-vessel" sign on Doppler ultrasonography

We describe the "double-vessel" sign and its relevance for the diagnosis of carotid and vertebral arterial anatomical variations in a series of four patients with stroke. In these four patients, two arteries could be seen at the expected location of the common carotid artery (CCA), leading to the diagnosis of anatomical variations including separate origin of internal and external carotid artery from the aortic arch on the left side and from the brachiocephalic trunk and the subclavian artery on the right side, early bifurcation of the CCA on both sides, and an aberrant course of the vertebral artery on the left side. The presence of two arteries at the expected location of the CCA should raise the suspicion of carotid or vertebral arterial variations.

Anatomically specific clinical examination of the carotid arterial tree

Clinical examination of the carotid arterial system has traditionally been used as a non-specific screening tool of atherosclerotic pathology. Because it has not yet been shown to delineate the precise location and grade of stenosis, further imaging modalities, such as duplex ultrasound, digital subtraction angiography, computed tomography and magnetic resonance, are currently used to obtain this information. These, however, have been shown to be susceptible to inaccuracies. Herein, a new protocol for bedside clinical examination that may define anatomical locality and degree of disease is presented. This consists of palpating the carotid pulse and auscultating for bruits along the course of the common carotid, internal carotid and external carotid arteries, as defined by surface anatomical landmarks from the lower neck to the pharynx. This protocol is not to replace more conventional methods of disease assessment but, in an era of diminishing clinical skills, may add to the overall evaluation of the pathological carotid tree.

Tortuous internal carotid artery indenting the piriform sinus: a case report

A case of tortuous internal carotid artery bulging and partially obliterating the piriform sinus, causing a sensation of fullness and abnormal throat, accompanied by choking spells in a 57-year-old patient is presented. Endoscopic examination and computerized tomographic angiography were useful in establishing the diagnosis. This rare anomaly should be recognized in order to prevent possible fatal hemorrhages during further surgical interventions of the piriform sinus.