Right Aortic Arch Related to Kommerell Diverticulum and Internal Carotid Artery Agenesis

We present a case of unilateral internal carotid artery (ICA) agenesis with trans-sellar anastomosis associated with a right aortic arch, and discuss the embryonic development and clinical implications of this condition. A 26-year-old woman without significant medical history was referred to our hospital complaining of tinnitus. She denied any other symptoms, and examination did not reveal any other neurological deficits. Radiological examinations showed agenesis of the right ICA with trans-sellar anastomosis, and a right aortic arch. This vascular configuration reflects the anatomical homology with avian vascular structure. Recognition of this anomaly has important implications for clinical situations, such as the planning of carotid or transsphenoidal surgery, the management of thromboembolic disease, and the surveillance and detection of associated cerebral aneurysms.

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Anatomical Predictors of Left Internal Carotid Artery Catheterization in Transradial Angiography

10.1101/2021.10.07.21264684 ◽

2021 ◽

Author(s):

Seon Woong Choi ◽

Hoon Kim ◽

Seong Rim Kim ◽

Ik Seong Park ◽

Sunghan Kim

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Aortic Arch ◽

Subclavian Artery ◽

Internal Carotid ◽

Multivariable Analysis ◽

Innominate Artery ◽

Left Internal Carotid Artery ◽

Arch Height ◽

Contrast Enhanced

ABSTRACTIntroductionTransradial angiography (TRA) has received considerable attention in the field of neurointervention owing to its advantages over transfemoral approaches. However, the difficulty of left internal carotid artery (ICA) catheterization under certain anatomical conditions of the aortic arch and its branches is a limitation of TRA. This study aimed to investigate the anatomical predictors of successful catheterization of the left ICA in TRA.Materials and MethodsFrom January 2020 to October 2020, 640 patients underwent TRA at a single institute. Among them, 263 consecutive patients who were evaluated by contrast-enhanced MRI before TRA were included in our study and assigned to success and failure groups, according to whether left ICA catheterization was possible or not. Anatomical predictors that may affect the success of left ICA catheterization in TRA were investigated for the purposes of our study.ResultsThe multivariable analysis included variables that demonstrated significant univariate associations with ICA catherization (P<0.0001). Variables included in the model were the type of aortic arch, height of right subclavian artery, turn-off angle of the left common carotid artery (CCA), distance between innominate artery to the left CCA, angulation of right subclavian artery, and angulation of the left CCA, which we identified as significant predictors of left ICA catheterization.ConclusionSuccess of left ICA catheterization in TRA was related to the vascular geometry of the aortic arch and its branches. Evaluating the anatomical predictors identified in this study using pre-procedure imaging may enhance the success rate of left ICA catheterization in TRA.

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Congenital horner's syndrome associated with unilateral agenesis of the internal carotid artery and unusual aortic arch anomaly

International Journal of Angiology ◽

10.1007/s00547-004-1016-8 ◽

2011 ◽

Vol 12 (04) ◽

pp. 266-269 ◽

Cited By ~ 1

Author(s):

Hüseyin Özdemir ◽

Kamran Mahmutyazicioğlu ◽

Aysun Ünal ◽

Ahmet Savranlar ◽

H. Tuğrul Atasoy ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Aortic Arch ◽

Internal Carotid ◽

Horner’S Syndrome ◽

Horner's Syndrome ◽

Aortic Arch Anomaly

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Republished: Separate origins of the left internal and external carotid arteries from the aortic arch and cervical internal carotid artery aneurysm in a patient with Noonan syndrome

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2016-012482.rep ◽

2016 ◽

Vol 9 (4) ◽

pp. e11-e11 ◽

Cited By ~ 4

Author(s):

Rizwan Ahmad Tahir ◽

Karam Asmaro ◽

Aqueel Pabaney ◽

Max Kole ◽

Timothy Nypaver ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Aortic Arch ◽

Noonan Syndrome ◽

Internal Carotid ◽

Anatomical Variation ◽

Artery Aneurysm ◽

External Carotid ◽

Fetal Life ◽

Internal Carotid Artery Aneurysm

Distinct origins of the external carotid artery and the internal carotid artery (ICA) from the aortic arch have been rarely described, and represent an aberrant development of the aortic arches during fetal life. This anatomical variation is usually discovered incidentally; infrequently, an aneurysm of the cervical ICA might accompany this rare configuration. We describe one such case in a patient with Noonan syndrome who presented with pulsatile neck mass. The diagnostic features and management of the aneurysm and a review of the literature are presented.

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Carotid stenting through the right brachial approach for left internal carotid artery stenosis and bovine aortic arch configuration

European Radiology ◽

10.1007/s00330-009-1355-0 ◽

2009 ◽

Vol 19 (8) ◽

pp. 2009-2015 ◽

Cited By ~ 17

Author(s):

Piero Montorsi ◽

Stefano Galli ◽

Paolo Ravagnani ◽

Sarah Ghulam Ali ◽

Daniela Trabattoni ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Aortic Arch ◽

Carotid Artery Stenosis ◽

Internal Carotid ◽

Carotid Stenting ◽

Internal Carotid Artery Stenosis ◽

Left Internal Carotid Artery ◽

The Right ◽

Bovine Aortic Arch

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Aberrant origin of left vertebral artery: a rare case

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20170177 ◽

2017 ◽

Vol 5 (2) ◽

pp. 700 ◽

Cited By ~ 1

Author(s):

Amanjeet S. Kindra ◽

Suneel K. Gupta

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Vertebral Artery ◽

Aortic Arch ◽

Subclavian Artery ◽

Common Carotid Artery ◽

Rare Case ◽

Internal Carotid ◽

Left Common Carotid Artery ◽

Left Vertebral Artery

The Vertebral Artery (VA) is classically described as originating as the first branch of the ipsilateral subclavian artery. The VA origin is variable and has been identified at the aortic arch, Common Carotid Artery (CCA), and Internal Carotid Artery. The VA arising from the carotid artery is an extremely uncommon variant. Left VA origin from the left CCA has been reported only thrice. These rare anomalous origins of the VA usually are asymptomatic. We describe symptomatic aberrant origin of left vertebral artery from left common carotid artery, a rare case.

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Abstract 1122‐000076: Direct Carotid Artery Cutdown and Flow Diversions for the Bilateral Dissecting Pseudo‐Aneurysms

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000076 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Yahia M Lodi ◽

Varun V Reddy ◽

Zara T Lodi ◽

Ravi Pande

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Aortic Arch ◽

Internal Carotid ◽

Retrospective Chart Review ◽

Flow Diverter ◽

Vascular Surgeon ◽

Alternative Option ◽

Ct Angiogram ◽

Severity Of The Disease

Introduction : flow diverters (FD) have been used for the treatment of the dissecting pseudo aneurysm (DSA) via trans femoral or transradial approach. Both trans femoral and transradial approaches require aortic arch as a relay to access the internal carotid artery (ICA). Presence of an aortic arch stent prevents navigating to the ICA. Therefore, alternative option such as direct Carotid artery Cutdown (DCAC) and FD for the treatment of the DSA in the ICA is not known. Methods : Case report and Retrospective chart review. Results : 67 years old man with history of hypertension, hyperlipidemia, smoking, and repair of the aortic arch aneurysm using a and aortic arch stenting. Patient was diagnosed with bilateral internal carotid artery DSA buy a CT angiogram when complained of neck pain, headaches and dizziness. Right ICA DSA was in multi‐level extending from cervical carotid artery to the skull base measured 19 × 15 × 20 mm and the left was 16 × 9 × 22 mm. An angiogram was attempted for the better evaluation of the DSA, which fail due to the presence of aortic arch stent. Considering the severity of the disease and the presence of symptoms, it was planned to have a DCAC by vascular surgeon followed by the repair of the aneurysms using FD by neurovascular surgeon (NES) in a staged fashion. Preparation: blood pressure was controlled and smoking was ceased. Patient was given 4 chewable baby aspirin and 300 mg clopidogrel on the day of the procedure. Activated coagulation time was kept 2 times of baseline. A 6F sheath was placed from right common carotid artery (CCA) to right ICA by a vascular surgeon and the placement was confined by NES by angiography. A CAT5 intermediate catheter was navigated to the ICA beyond DSA. FD was achieved using Surpass streamline measuring 4 × 50 mm x2 and a 5 × 40 mm to cover the entire DSA and disease ICA. The DCAC site was sutured by vascular surgeon and patient was extubated. Patient was discharged home in 48 hours with NIHSS 0 and mRS 1 as baseline. Using similar techniques, Left‐sided dissecting pseudoaneurysm repaired using 5 × 50 mm surpass streamline flow diverter. Patient was discharged in 24 hours. Patient continued 325 mg of aspirin and 75 mg of aspirin for six months followed by 81 mg baby aspirin and 75 mg of clopidogrel. Six‐month follow‐up MR angiogram demonstrate complete obligations of the bilateral DPA and remodeling of the internal carotid arteries. Conclusions : When transfemoral or transtibial approach is not feasible, DCACW could be an alternative option for the treatment of the symptomatic and life‐threatening DSA of the Internal carotid artery. Further studies are required.

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