Posterior Circulation Approach for Anterior Circulation Thrombectomy in a Patient with Dysgenetic Internal Carotid Artery.

Abstract

Dysgenesis of the internal carotid artery is a rare congenital variation that is mostly asymptomatic. The key to the imaging diagnosis is the identification of a narrow bony carotid canal. Dysgenetic carotid is a hindrance for endovascular access for ipsilateral intracranial anterior circulation, timely identification and differentiation from collapsed ICA secondary to intracranial occlusion can help guide timely access to mechanical thrombectomy via embryonic collateral routes which are usually prominent in those individuals. We describe a patient with hyperacute ischemic stroke with middle cerebral artery occlusion with the similar anatomic variation of ipsilateral internal carotid artery treated with mechanical thrombectomy using posterior circulation access from vertebral artery bridging to anterior circulation across posterior communicating artery after timely recognition of the anomaly.