Carotid endarterectomy for treatment of tandem carotid stenosis in the presence of the anomalous origin of the occipital
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JOURNAL OF MEDICAL
CASE REPORTS
CASE REPORT
Open Access
Carotid endarterectomy for treatment of tandem carotid stenosis in the presence of the anomalous origin of the occipital artery arising from the cervical internal carotid artery: a case report Gakushi Yoshikawa*, Mariko Kawashima and Kazuo Tsutsumi
Abstract Introduction: Branches from the cervical portion of the internal carotid artery are rare. In most cases, atherosclerotic stenosis is found at the bifurcation of the internal and external carotid arteries. However, when associated with atherosclerotic carotid artery disease, the origin of the rare branches arising from the internal carotid artery can be another site of stenosis. This report describes a rare case of such tandem carotid stenosis treated by carotid endarterectomy and the importance of the possibility of stenosis at the origin of the anomalous branch from the internal carotid artery. Case presentation: A 73-year-old Japanese woman presented with transient left hemiparesis and vertigo. Magnetic resonance angiography seemed to indicate two stenotic lesions distal to the right internal carotid artery in addition to the origin of the right internal carotid artery, and angiography indicated tandem stenotic lesions of the internal carotid artery. The patient was successfully treated with right carotid endarterectomy, including the distal stenotic lesion of internal carotid artery, and postoperative angiography indicated that the occipital artery arose from the internal carotid artery. Conclusion: It is important to recognize rare cases of the anomalous origin of the occipital artery from the internal carotid artery and the possibility that the origin of such an anomalous occipital artery may be the cause of stenosis. Keywords: Anomalous branch, Carotid endarterectomy, Tandem stenosis
Introduction Branches of the extracranial portion of the internal carotid artery (ICA) are rare. Although atherosclerotic stenosis is commonly found at the origin of the ICA from the common carotid artery, when associated with atherosclerotic carotid disease, the origin of the rare branch from the ICA can be another site of atherosclerotic stenosis. In this report, we describe the case of a patient with symptomatic tandem atheromatous plaques of the ICA located not only at the common stenotic site of the origin of the ICA but also at the anomalous origin of the occipital artery from the ICA.
* Correspondence: [email protected] Department of Neurosurgery, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira City, Tokyo 187-8510, Japan
Case presentation A 73-year-old Japanese woman presented with a recent episode of vertigo and transient left upper-extremity weakness and numbness. The patient had only hypertension and no history of coronary artery disease, diabetes or smoking. Her neurological examination revealed no remarkable findings. Magnetic resonance imaging demonstrated two stenotic lesions at the distal right ICA in addition to the origin of the ICA but no evidence of cerebral infarction. Carotid angiogr
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