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Case Reports
. 2016 Apr;10(4):TD03-4.
doi: 10.7860/JCDR/2016/17797.7549. Epub 2016 Apr 1.

Congenital Absence of Internal Carotid Artery with Rare Type of Intercavernous Anastamosis and Ruptured Cerebral Aneurysm

Anand Alurkar  1 , Lakshmi Sudha Prasanna Karanam  2 , Sagar Oak  2 , Smita Kori  3
Affiliations
Case Reports

Congenital Absence of Internal Carotid Artery with Rare Type of Intercavernous Anastamosis and Ruptured Cerebral Aneurysm

Anand Alurkar et al. J Clin Diagn Res. 2016 Apr.

Abstract

Congenital absence of Internal Carotid Artery (ICA) is a rare anomaly seen in <0.01% of the population. Various collateral circulations develop in these cases to maintain adequate cerebral perfusion. High incidence of aneurysms is reported in these cases. Complete evaluation is required to detect other abnormalities usually seen in these patients. We report a case of congenital absence of right ICA in a 39-year-old female who presented with Subarachnoid Haemorrhage (SAH) and had a Middle Cerebral Artery Aneurysm (MCA). The right MCA got supply from the intercavernous communication from the left internal carotid artery. Skull base Computed Tomogram (CT) confirmed the congenital absence of right ICA. She underwent successful surgical clipping for the aneurysm. The high incidence of aneurysms, collateral circulations, embryological development and postulated mechanisms of this anomaly were discussed. The exact aetiology behind the absence of ICA remains unclear. It is important to differentiate this condition from acquired stenosis/occlusion due to atherosclerosis and carotid dissection. Recognising the anomaly is important and gains even more significance during surgical planning in cases of direct aneurysm clipping, carotid endarterectomy and transphenoidal surgeries.

Keywords: Carotid agenesis; Cerebral perfusion; Collaterals.

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Figures

[Table/Fig-1]:
[Table/Fig-1]:
Plain CT scan images (A and B) showing subarachnoid haemorrhage predominantly in the right sylvian fissure as shown by the arrow.
[Table/Fig-2]:
[Table/Fig-2]:
Arch angiogram showing direct origin of right common carotid artery from the aorta which is uniformly small in calibre.
[Table/Fig-3]:
[Table/Fig-3]:
Anteroposterior view of the Left internal carotid angiogram (ICA) showed intercavernous collateral communication as shown by white arrows (3A). Right MCA bifurcation aneurysm is shown on the enlarged anteroposterior view of the left ICA (3B).
[Table/Fig-4]:
[Table/Fig-4]:
High Resolution CT scan of the base of skull shows the normally developed left carotid canal (single arrow) and a dimunitive one on the right side (double arrow)
See this image and copyright information in PMC

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