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Review
. 2006 Jun-Jul;27(6):1304-6.

MR angiographic demonstration of bilateral duplication of the extracranial vertebral artery: unusual course and review of the literature

C Ionete  1 , M F Omojola
Affiliations
Review

MR angiographic demonstration of bilateral duplication of the extracranial vertebral artery: unusual course and review of the literature

C Ionete et al. AJNR Am J Neuroradiol. 2006 Jun-Jul.

Abstract

Duplication of the vertebral artery is a rare developmental anomaly. Duplication and fenestration are terms often used incorrectly and interchangeably in the literature. To the best of our knowledge, this is the first report to describe bilateral duplication of the extracranial vertebral artery. Bilaterally, there are 2 separate origins of each vertebral artery from the corresponding subclavian artery, with one duplicated segment entering the C7 foramen transversarium bilaterally and the other segment entering the carotid space on either side. The duplicated vessels join together at C5-C6 disk level on the left and at C4-C5 disk level on the right before continuing as one vessel in the foramina transversaria on either side. Duplication is thought to represent failure of controlled regression of 2 intersegmental arteries and a segment of the primitive dorsal aorta. This case was discovered on a 2D time-of-flight and contrast-enhanced neck MR angiogram in an 83-year-old man with cognitive decline and appears as an incidental finding without obvious clinical implications.

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Figures

Fig 1.
Fig 1.
Right oblique view of maximum intensity projection of 3D contrast-enhanced MRA of the neck, showing bilateral proximal duplication of the vertebral arteries. Vertical arrows point to the 2 origins of the left vertebral artery. Curved arrow points to the union of the 2 left vertebral artery components. Transverse arrows point to the 2 origins of the right vertebral artery. Arrowhead points to the union of the 2 right vertebral artery components.
Fig 2.
Fig 2.
Transverse source image from the 2D TOF MRA of the neck at C7 vertebral level showing the vertebral arteries in the foramen transversarium (single vertical arrow points to the right vertebral artery; double vertical arrows point to the left vertebral artery). The duplicated limb on the right (curved arrow) is located intimately medial to the right common carotid artery, whereas the duplicated vessel on the left (transverse arrow) is located posteromedially to the left common carotid artery.
Fig 3.
Fig 3.
Schematic representation of the embryology of the duplication of the bilateral vertebral arteries. Modified from Goddard et al.
See this image and copyright information in PMC

References

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