Rare congenital anomalies of the internal carotid artery: anatomic and radiologic aspects of three cases and review of t
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ORIGINAL ARTICLE
Rare congenital anomalies of the internal carotid artery: anatomic and radiologic aspects of three cases and review of the literature Hilal Akdemir Aktaş1 · Mine Farımaz2 · Ayşegül Fırat1 · Rahşan Göçmen3 Received: 23 March 2020 / Accepted: 11 August 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Purpose Congenital anomaly of the internal carotid artery (ICA) is a rare entity. It is usually discovered incidentally by color doppler carotid sonography, angiography, computerized tomography (CT), or magnetic resonance imaging of the head and neck region taken for some other reasons. The aim of this study was to detect congenital ICA anomalies, to delineate existing collateral vessels and to find out its incidence. Methods 1847 patients’ CT angiography images of the head and neck region taken between May 2013 and February 2018 were retrospectively evaluated for ICA anomalies. Results We detected three cases (0.16%) with unilateral agenesis of ICA, bilateral agenesis of ICA and bilateral hypoplasia of ICA, respectively. Most patients are asymptomatic because of collateral cerebral circulation supplied by the communicating arteries of the circle of Willis, intercavernous anastomosis, communicating arteries from the external carotid artery, and by persistent embryologic arteries to the carotid artery territory. Conclusion Recognition of ICA anomalies has important implications during planned carotid or transsphenoidal surgery, in thromboembolic disease, and in the follow-up and detection of associated cerebral aneurysms. Keywords Internal carotid artery · Agenesis · Hypoplasia · CT angiography
Background Congenital anomaly of the internal carotid artery (ICA) is a rare entity [4, 22]. It is usually discovered incidentally by color doppler carotid sonography, angiography, computerized tomography (CT), or magnetic resonance imaging (MRI) of the head and neck that are taken for some other reasons [22, 26]. The prevalence of the ICA anomalies has been reported to be around 0.01% in the literature [24, 25]. According to Lasjaunias et al. [12], the different segments of ICA arise from different embryologic segments, specifically the following arteries: ventral pharyngeal, hyoid, mandibular, primitive maxillary, trigeminal, dorsal ophthalmic, * Hilal Akdemir Aktaş [email protected] 1
Faculty of Medicine, Department of Anatomy, Hacettepe University, Ankara, Turkey
2
Faculty of Medicine, Department of Anatomy, Ufuk University, Ankara, Turkey
3
Faculty of Medicine, Department of Radiology, Hacettepe University, Ankara, Turkey
and ventral ophthalmic. Agenesis of the ICA occurs due to abnormal regression of the first and third aortic arch, with the exact etiology being unclear. The terms agenesis, and hypoplasia are often misused in the setting of an absent or small ICA. Lie and Hage [17] defined agenesis as the total absence of ICA, whereas hypoplasia refers to cases where a segment or whole length of the ICA is narrower. For this reason, the bony carotid canal
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