Congenital absence of the internal carotid artery with intercavernous anastomosis

Abstract

Congenitally absent internal carotid artery with intercavernous anastomosis is an exceedingly rare vascular anomaly. We report such a case in a 65-year-old man with chronic symptoms resembling sporadic transient ischemic attacks. While these patients are usually asymptomatic due to compensatory collateralization, they are at increased risk of aneurysm formation, and thus proper identification is important. This report serves as both a case of a very rare anomaly and as a lesson on how to avoid this misdiagnosis by carotid duplex sonography. Additionally, we review the limited number of published cases of congenitally absent internal carotid artery with intercavernous anastomosis.

The ambiguous “internal carotid artery”–Ultrasound diagnosis of congenital absence of the internal carotid artery: A case report and review of the literature

“…The RACA A1 was absent, the RACA was supplied by the LACA via the ACoA, and the RMCA was supplied by the LICA through the intercavernous branch of the cavernous sinuses. According to the study results of Jesse et al, [8] the incidence of intracranial aneurysms was approximately 2% to 4% in the general population but as high as 25% to 43% in patients with congenital absence of the ICA, which might be caused by congenital dysplasia of the vascular wall or abnormal hemodynamics. [1,9] Therefore, early and accurate diagnosis of congenital absence of the ICA and regular monitoring of the formation and development of intracranial aneurysms are important for preventing cerebral hemorrhage and subarachnoid hemorrhage.…”

The Ambiguous "Internal Carotid Artery" - Ultrasound Diagnosis of One Case of Congenital Absence of the Internal Carotid Artery

“…Some patients may experience noncharacteristic symptoms such as tinnitus, dizziness, headache, etc., and a small number of patients may be admitted to the hospital due to aneurysm rupture or epilepsy [4] . Lie [5] divided congenital absence of ICA into 6 types according to the compensatory pathways of collateral circulation. In Type A (unilateral absence of the ICA), the most common type encountered in clinical practice, the affected ACA is supplied by the contralateral ACA via the ACoA, and the affected MCA is supplied by the ipsilateral posterior cerebral artery (PCA).…”

Internal carotid artery agenesis presenting with ruptured Acom aneurysm: Rare case report

“…Developmental anomalies of internal carotid artery (ICA) are rare entities and can be considered under agenesis, aplasia, and hypoplasia [ 6 ]. Most of these cases are asymptomatic in itself [ 7 ] because of collateral circulation from the circle of Willis (through the contralateral ICA or vertebrobasilar system) or through the persistent primitive pathways (trans-cavernous anastomosis) or extracranially through the external carotid artery (ECA) [ 2 ]. Lie classified these anomalies into six types [ 6 ].…”