Abstract
IntroductionBranches from the cervical portion of the internal carotid artery are rare. In most cases, atherosclerotic stenosis is found at the bifurcation of the internal and external carotid arteries. However, when associated with atherosclerotic carotid artery disease, the origin of the rare branches arising from the internal carotid artery can be another site of stenosis. This report describes a rare case of such tandem carotid stenosis treated by carotid endarterectomy and the importance of the possibility of stenosis at the origin of the anomalous branch from the internal carotid artery.Case presentationA 73-year-old Japanese woman presented with transient left hemiparesis and vertigo. Magnetic resonance angiography seemed to indicate two stenotic lesions distal to the right internal carotid artery in addition to the origin of the right internal carotid artery, and angiography indicated tandem stenotic lesions of the internal carotid artery. The patient was successfully treated with right carotid endarterectomy, including the distal stenotic lesion of internal carotid artery, and postoperative angiography indicated that the occipital artery arose from the internal carotid artery.ConclusionIt is important to recognize rare cases of the anomalous origin of the occipital artery from the internal carotid artery and the possibility that the origin of such an anomalous occipital artery may be the cause of stenosis.
Highlights
Branches from the cervical portion of the internal carotid artery are rare
The patient was successfully treated with right carotid endarterectomy, including the distal stenotic lesion of internal carotid artery, and postoperative angiography indicated that the occipital artery arose from the internal carotid artery
Atherosclerotic stenosis is commonly found at the origin of the internal carotid artery (ICA) from the common carotid artery, when associated with atherosclerotic carotid disease, the origin of the rare branch from the ICA can be another site of atherosclerotic stenosis
Summary
Branches of the extracranial portion of the internal carotid artery (ICA) are rare. atherosclerotic stenosis is commonly found at the origin of the ICA from the common carotid artery, when associated with atherosclerotic carotid disease, the origin of the rare branch from the ICA can be another site of atherosclerotic stenosis. We describe the case of a patient with symptomatic tandem atheromatous plaques of the ICA located at the common stenotic site of the origin of the ICA and at the anomalous origin of the occipital artery from the ICA. The patient had only hypertension and no history of coronary artery disease, diabetes or smoking Her neurological examination revealed no remarkable findings. Carotid angiography revealed tandem stenotic lesions at the origin of the ICA and distal to the ICA (Figures 1A and 1B). Post-operatively, the patient remained neurologically intact, and angiography revealed that the anomalous branch from the ICA at the distal stenotic site was the occipital artery (Figures 2A and 2B). Pathological examination of the plaque revealed marked atherosclerosis with calcification
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