Internal Carotid Artery Tortuosity as a Rare Cause of Dysphagia: Case Report and Literature Review

Antunes, Inês; Machado, Rui; Rego, Duarte; Ferreira, Vı́tor F.; Gonçalves, João; Teixeira, Gabriela; Veiga, Carlos; Mendes, Daniel; Pereira, Carlos; Almeida, Rui

doi:10.1016/j.avsg.2018.04.045

Cited by 4 publications

(5 citation statements)

References 13 publications

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“…The abnormal pattern in this specific case fits in the human classification system as an elongated tortuous artery with coiling (curving) (Antunes et al, 2018;Weibel & Fields, 1965), potentially resulting in compression of the cranial nerves.…”

Section: Discussionmentioning

confidence: 58%

Neurologic deficits and surgical treatment in a horse affected with internal carotid artery tortuous elongation

Rijkenhuizen,

Kaske,

Rikart

et al. 2023

Equine Veterinary Education

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SummaryA 2‐year‐old Warmblood gelding was presented with a history of bilateral feed material coming from the nostrils secondary to dysphagia, coughing and impairment of physical development, since purchase at 6 months of age. Endoscopy of the right guttural pouch was unremarkable; however, in the left guttural pouch, a distended (aneurysm), pulsating, tortuous elongated internal carotid artery (ICA) was observed. Computed tomography revealed that in the dorsal aspect of the medial compartment of the left guttural pouch adjacent to the jugular foramen, the ICA turned anti‐clockwise creating a small loop of 1 cm diameter. This loop had a faint linear, soft tissue attenuating connection to the caudodorsal wall of the guttural pouch and was slightly larger in diameter compared to the right ICA. A malformation of the left ICA was diagnosed, most likely congenital. A secondary compression and neuropathy of one or multiple nerves of the associated lower cranial nerves in the neurovascular plica (IX, X) was suspected explaining the clinical signs of dysphagia. The slightly larger diameter of the left ICA could represent congestion of the vessel or an early aneurysm formation. Based on these findings, endovascular balloon occlusion (nondetachable balloon) of the left ICA was performed to relief the compression on the affected nerves. The occlusion of the ICA resolved the clinical signs within 7 weeks after surgery.

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Section: Discussionmentioning

confidence: 58%

Neurologic deficits and surgical treatment in a horse affected with internal carotid artery tortuous elongation

Rijkenhuizen,

Kaske,

Rikart

et al. 2023

Equine Veterinary Education

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“…As a result of the analysis in this study of all the items of EAT-10, it was seen that patients with PAICA experienced most problems swallowing solid food. Ozturk et al [14], Stilo et al [22], and Antunes et al [23] reported three separate PAICA cases with dysphagia. Consistent with the current study findings, those case reports also stated that patients had problems swallowing solid foods.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Oropharyngeal Dysphagia in Elderly Patients with Pharyngeal Aberrant Internal Carotid Artery Using the Eating Assessment Tool-10 (EAT-10)

et al. 2021

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Pharyngeal aberrant internal carotid artery (PAICA) has been reported to be a cause of oropharyngeal dysphagia (OD) in case reports. However, as there have been no clinical studies, the relationship between PAICA and OD is not clear. The aim of this study was to investigate the perception of OD in elderly PAICA patients using the Eating Assessment Tool-10 (EAT-10). A study group (Group 1) was formed of patients diagnosed with PAICA from the visualization of a pulsatile mass in the pharynx in flexible fiberoptic endoscopic examination and carotid magnetic resonance angiography tests, and a control group (Group 2) was formed of age-matched healthy volunteers. The study group was subdivided as patients with unilateral PAICA (Group 1a) and patients with bilateral PAICA (Group 1b). The Turkish version of the EAT-10 was applied to all the participants. Total EAT-10 points of ≥ 3 were accepted as abnormal. Normal (< 3) and abnormal (≥ 3) total EAT-10 points were determined in 88.9% (24/27) and 11.1% (3/27), respectively, of the control group, in 55.2% (16/29) and 44.8% (13/29) of Group 1, in 70.6% (12/17) and 29.4% (5/17) of Group 1a, and in 33.3% (4/12) and 66.7% (8/12) of Group 1b. A statistically significant difference was determined between the control group and Group 1 and Group 1b in respect of abnormal (≥ 3) EAT-10 total points (p = 0.007, p = 0.001, respectively). No statistically significant difference was determined between the control group and Group 1a (p = 0.227). Problems (EAT point ≥ 1) in item 4 (swallowing solids takes extra effort) were experienced by 13 (44.8%) patients in Group 1, 9 (75%) patients in Group 1b, and 5 (18.5%) subjects in the control group (p < 0.05). These results demonstrated that unilateral PAICA does not significantly affect swallowing, whereas bilateral PAICA created a significant negative effect. These patients experience more problems when swallowing solid food.

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“…Findings in the literature concluded that there are few possibilities of curative treatment, particularly for patients with nonlife‐threatening symptoms 1,5,10 . In these patients, a close follow‐up is generally proposed to ensure the absence of pejorative evolution 10 .…”

Section: Discussionmentioning

confidence: 99%

“…6 Findings in the literature concluded that there are few possibilities of curative treatment, particularly for patients with nonlife-threatening symptoms. 1,5,10 In these patients, a close follow-up is generally proposed to ensure the absence of pejorative evolution. 10 Moreover, lifestyle and dietary measures are sometimes proposed such as adaptation of the diet (soft diet, avoidance of risky foods such as fish bones and chicken bones, etc.).…”

Section: Discussionmentioning

confidence: 99%

“…1,5,10 In these patients, a close follow-up is generally proposed to ensure the absence of pejorative evolution. 10 Moreover, lifestyle and dietary measures are sometimes proposed such as adaptation of the diet (soft diet, avoidance of risky foods such as fish bones and chicken bones, etc.). In rare cases of cerebrovascular insufficiency, several teams have attempted a surgical approach to prevent artery thrombosis and stroke.…”

Section: Discussionmentioning

confidence: 99%

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Having a carotid in the throat: A rare case of internal carotid medialization‐induced dysphonia

De Stercke,

Dequanter,

Rodriguez

2023

Clinical Case Reports

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Key Clinical MessagePositional anomalies of the internal carotid artery are common. Often asymptomatic, they can cause dysphagia or dysphonia and can represent an important surgical risk. Knowing their existence is, therefore, essential for the ENT specialist.AbstractAberrant positions of the extracranial internal carotid artery (eICA) affect between 10 and 40% of the population and can present several forms that can bring them close to the pharyngeal walls. Although usually asymptomatic, some aberrant positions of eICA may cause symptoms such as cough or dysphagia but rarely dysphonia. Depending on their location, they can also represent a great risk during oro/hypopharyngeal interventions or intubations. We report here the case of a 72‐year‐old patient who presented for a first consultation with a little progressive chronic dysphonia without associated dysphagia or cough. The nasofibrostroboscopy revealed a pulsatile retrocricoid mass pushing the right arytenoid forward. Otherwise, the clinical examination of the ENT sphere was normal. A cervicofacial CT scan revealed a major medialization of the right carotid bifurcation and the eICA located within the retropharyngeal fatty space and causing a mass effect pushing forward and downward the right arytenoid and the piriform sinus, resulting in a loss of horizontality of the glottic plane. Given the absence of life‐threatening complications and the associated risk of surgery, no treatment was proposed. A follow‐up was established after discussion with the patient. The aim of this study was to describe a rare case of isolated dysphonia caused by right internal carotid medialization with mass effect on the arytenoid cartilage. It seems important for ENT to know these rare causes of dysphonia and/or dysphagia due to anatomical variations of eICA in order to avoid the operative risks associated with possible future therapeutic procedures in these patients.

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Internal Carotid Artery Tortuosity as a Rare Cause of Dysphagia: Case Report and Literature Review

Cited by 4 publications

References 13 publications

Neurologic deficits and surgical treatment in a horse affected with internal carotid artery tortuous elongation

Neurologic deficits and surgical treatment in a horse affected with internal carotid artery tortuous elongation

Evaluation of Oropharyngeal Dysphagia in Elderly Patients with Pharyngeal Aberrant Internal Carotid Artery Using the Eating Assessment Tool-10 (EAT-10)

Having a carotid in the throat: A rare case of internal carotid medialization‐induced dysphonia

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