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Table of Contents    
NEUROIMAGES
Year : 2019  |  Volume : 67  |  Issue : 1  |  Page : 333-334

Bilateral carotid hypoplasia with multiple posterior circulation aneurysms


1 Department of Interventional Neurology, MAX Superspecialty Hospital Saket, New Delhi, India
2 Department of Neurology, MAX Superspecialty Hospital Saket, New Delhi, India
3 Department of Neurosurgery, MAX Superspecialty Hospital Saket, New Delhi, India

Date of Web Publication7-Mar-2019

Correspondence Address:
Dr. Chandril Chugh
MAX Superspecialty Hospital Saket, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.253613

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How to cite this article:
Agarwal H, Reddi R, Walia B, Chugh C. Bilateral carotid hypoplasia with multiple posterior circulation aneurysms. Neurol India 2019;67:333-4

How to cite this URL:
Agarwal H, Reddi R, Walia B, Chugh C. Bilateral carotid hypoplasia with multiple posterior circulation aneurysms. Neurol India [serial online] 2019 [cited 2019 Mar 18];67:333-4. Available from: http://www.neurologyindia.com/text.asp?2019/67/1/333/253613




A 67-year-old male patient with a history of hypertension and smoking presented with episodes of long-standing headache to the outpatient clinic. A computed tomographic angiogram was performed which showed the absence of bilateral internal carotid arteries and multiple aneurysms in the posterior circulation. Digital subtraction angiography showed bilateral internal carotid artery (ICA) hypoplasia and aneurysms at the top of the basilar artery and the junction of the left posterior communicating artery (pcomm) and the left posterior cerebral artery [Figure 1]. The carotid canal was hypoplastic bilaterally on the CT scan, which is the hallmark of hypoplasia of the internal carotid artery.
Figure 1: DSA with 3D reconstruction: Right vertebral artery supplying bilateral anterior (a) and middle cerebral arteries (curved arrows in (b)), through pcomm arteries [thick arrows in (b)]. Double arrow and empty arrow in (b) denoting the right posterior cerebral artery (PCA) and left PCA, respectively. Aneurysms at the basilar tip and left P1 PCA–pcomm junction [thin arrows in (b)]. Hypoplastic right ICA (c) with corresponding hypoplastic right carotid canal (d). Hypoplastic left ICA (f) with corresponding hypoplastic left carotid canal (e)

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This case highlights an extremely uncommon congenital anomaly of bilateral carotid hypoplasia associated with multiple aneurysms. Embryologically, the internal carotid artery develops during the sixth week of gestation from the first and third aortic arches and the dorsal aorta. The carotid canal develops with the artery and its absence is a sign of carotid hypoplasia.[1],[2]

Various collateral pathways have been discussed in the literature associated with ICA hypoplasia. The most common pathway is the ipsilateral hemisphere being supplied via the hypertrophied posterior communicating and anterior communicating artery.[3] In our case, the entire anterior circulation was being supplied by the hypertrophied right vertebral artery through the two posterior communicating arteries. Aplasia of the internal carotid artery is associated with a high incidence of aneurysms due to increased hemodynamic stress (23–45% as compared to 2–4% in normal individuals).[4] Our patient had two aneurysms, at the top of the basilar artery and and at the left posterior communicating artery and left posterior cerebral artery junction. Due to hemodynamic factors, these aneurysms remain at high risk for rupture and any therapy to treat these aneurysms comes with its own set of challenges due to difficult anatomy and dysplastic vessels.

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Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Florio F, Balzano S, Nardella M, Strizzi V, Cammisa M, Bozzini V, et al. Congenital absence of the internal carotid artery. Cardiovasc Intervent Radiol 1999;22:74-8.  Back to cited text no. 1
    
2.
Kunishio K, Yamamoto Y, Sunami N, Asari S. Agenesis of the left internal carotid artery, and main trunk of the external carotid artery associated with multiple cerebral aneurysms. Surg Neurol 1987;27:177-81.  Back to cited text no. 2
    
3.
Lie TA. Congenital anomalies of the carotid arteries. Amsterdam: Excerpta Medica; 1968. p. 44-9.  Back to cited text no. 3
    
4.
Quint DJ, Boulos RS, Spera TD. Congenital absence of the cervical and petrous internal carotid artery with intercavernous anastomosis. AJNR Am J Neuroradiol 1989;10:435-9.  Back to cited text no. 4
    


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