Abstract
Unilateral and bilateral variation in the course and elongation of the cervical (extracranial) part of the internal carotid artery (ICA) leading to its tortuosity, kinking and coiling or looping is not a rare condition, which could be caused by both embryological and acquired factors. Patients with such variations may be asymptomatic in some cases; in others, they can develop cerebrovascular symptoms due to carotid stenosis affecting cerebral circulation. The risk of transient ischemic attacks in patients with carotid stenosis is high and its surgical correction is indicated for the prevention of ischemic stroke. Detection of developmental variations of the ICA and evaluation of its stenotic areas is very important for surgical interventions and involves specific diagnostic imaging techniques for vascular lesions including contrast arteriography, duplex ultrasonography and magnetic resonance angiography. Examination of obtained images in cases of unusual and complicated variations of vascular pattern of the ICA may lead to confusion in interpretation of data. Awareness about details and topographic anatomy of variations of the ICA may serve as a useful guide for both radiologists and vascular surgeons. It may help to prevent diagnostic errors, influence surgical tactics and interventional procedures and avoid complications during the head and neck surgery. Our present study was conducted with a purpose of updating data about developmental variations of the ICA. Dissections of the main neurovascular bundle of the head and neck were performed on a total 14 human adult cadavers (10 – Africans: 7 males & 3 females and 4 – East Indians: all males). Two cases of unilateral congenital elongation of the cervical part of the ICA with kinking and looping and carotid stenoses were found only in African males. Here we present their detailed case reports with review of the literature.
Highlights
Among other vascular systems the system of carotid arteries represents a special interest for medical professionals involved in diagnosis and management of vascular diseases
Two cases of unilateral elongation of the cervical part of the internal carotid artery (ICA) with kinking and looping and obvious carotid stenosis in African males, presented in our study, have clearly demonstrated some morphological details, which could not be obtained during clinical examination of patients involving modern imaging techniques
A possibility of insufficient cerebrovascular circulation due to carotid stenosis in both cases could be compensated by the enlarged vertebral arteries on the sides of carotid occlusions, which may suggest their congenital nature
Summary
Among other vascular systems the system of carotid arteries represents a special interest for medical professionals involved in diagnosis and management of vascular diseases. Carotid occlusions could be caused by many factors including kinking and looping of the ICA. Such occlusions traditionally require surgical interventions with constantly (page number not for citation purposes). Deviations of embryonic development of blood vessels from the most common patterns are frequently encountered and widely recognized [2,3,4,5,6,7,8,9,10]. A complicated process of transformation of the embryonic aortic arch system, which involves regression and disappearance, retention, or reappearance of its components, may result in congenital anatomical variations in the origin and courses of the vessels, Moore [7]. A differential growth may shift origin of some arteries, which appear as anomalous
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