Aberrant Internal Carotid Artery Research Articles

Branching and nonbranching intracranial aneurysms in the presence of a persistent stapedial artery and an aberrant internal carotid artery assessed with computational hemodynamics: illustrative case.

The mechanisms underlying the initiation and progression of bifurcation versus lateral wall aneurysms are not well understood. Computational fluid dynamics (CFD) can improve the understanding of these mechanisms and can consequently help identify patients at higher risk for developing aneurysms and monitor them more closely. A 36-year-old man presented with a ruptured anterior communicating artery aneurysm, which was successfully treated with microsurgical clipping. Imaging also revealed a persistent stapedial artery with an elongated and tortuous posterior communicating artery (PComA). Fourteen years later, he was readmitted for a ruptured aneurysm on a PComA loop. CFD helped identify considerable collateral circulation due to the aberrant internal carotid artery (ICA). High flow rates trigger both types of aneurysms, but nuances exist in the hemodynamic mechanisms that drive their growth. Berry aneurysms and lateral wall aneurysms initially start due to a high flow rate, a common underlying cause. However, the formation of true sidewall aneurysms is primarily characterized by locally increased wall shear stress, while the development of berry aneurysms is mainly linked to high local blood pressure at arterial bifurcations. An aberrant ICA can lead to supraphysiological compensatory flow in the anterior and posterior circulation, increasing the risk of intracranial aneurysm formation at both branching and nonbranching sites, underscoring the need for lifelong monitoring. https://thejns.org/doi/10.3171/CASE24421.

A Clinicopathological Study of Aural Polyps: A Retrospective Analysis in a Tertiary Care Hospital.

Introduction Aural polyps are a misnomer. Any lesion can present as a mass in the external auditory canal. Aural polyps are proliferation of the granulation tissue due to long standing inflammatory process with associated otalgia and otorrhea. Objectives To document the clinicoradiological presentations, intraoperative findings, and histopathological diagnosis of aural polyp, correlating them. Methods In our study 81 patients underwent treatment for aural polyps in the department of Ear, Nose, and Throat (ENT) from April 1997 to April 2022. Results were tabulated, a simple descriptive analysis was done using the Statistical Package Social Sciences software, and the results obtained were represented as percentages and presented in tables. Results The majority (38) of the patients presenting with aural polyps were diagnosed with mucosal and squamous type of CSOM, and 22 with simple granulation polyps. There were also 5 patients with malignant otitis externa, 3 patients had glomus tumors, 2 patients with retained foreign bodies, and 3 patients with brain herniation. We also identified aberrant internal carotid artery, high jugular bulb, one patient had facial nerve neuroma, one patient had polyp from the tragus diagnosed with tuberculosis, one patient with keratosis obturans, and one with exostosis. Conclusion A thorough detailed examination and mastoid exploration with radiological and histopathological evaluation is mandatory for better defining the definitive treatment. Utmost care and meticulousness are advised for the surgeons while dealing with aural polyps to avoid any complications.

A Case of Duplicated Internal Carotid Artery with an Aberrant Internal Carotid Artery in the Middle Ear

A Case of Duplicated Internal Carotid Artery with an Aberrant Internal Carotid Artery in the Middle Ear

Relationship of aberrant internal carotid artery with pharyngeal wall in obstructive sleep apnea.

Obstructive sleep apnea (OSA) is a common clinical condition in which the upper airway partially or completely narrows or collapses during sleep. The objective of our research was to examine the relation between the abnormal internal carotid artery (ICA) and the pharyngeal wall among individuals suffering from OSA, and to compare it to a group of control subjects. In this retrospective study, the closest distances of the ICA to the pharyngeal walls and midlines were measured on CT images and compared between groups. The closest distance of the ICA to the right pharyngeal wall was 3.8 ± 2.4mm and the closest distance to the left pharyngeal wall was 4.1 ± 2.3mm in patients with OSA, which was significantly less than the controls (respectively, 4.4 ± 1.6mm and 14.4 ± 1.7mm) (p < 0.001). The closest distances of the ICA to the right and left pharyngeal walls (p = 0.001) and to the right and left midline (p = 0.00002) were significantly lower in patients with moderate to severe OSA compared to mild patients according to apnea / hypopnea index (AHI). In the retroglossal bifurcation of the common carotid artery (CCA), the closest distances of the ICA to the right (p = 0.027) and left pharyngeal walls (p = 0.018) and to the right (p = 0.01) and left midline (p = 0.012) were significantly lower than the retroepiglottic bifurcation of the CCA. We observed that the distance of the aberrant ICA to the pharyngeal wall is less in individuals with OSA than in individuals without OSA, the distance of the aberrant ICA to the pharyngeal wall decreased as the severity of AHI increased.

Trajet aberrant d'une artère carotide interne anévrismale révélé par une dysphonie et une toux chronique : à propos d'un cas

Aberrant internal carotid artery is a rare birth defect. It occurs when the artery takes an abnormal course, the discovery of which is fortuitous but in the presence of dysphonia or chronic cough; this anomaly remains a diagnosis of exclusion. Cervicothoracic CT scan with injection of contrast product confirms the diagnosis. We report the case of a 64-year-old patient who presented with an aberrant course of an aneurysmal internal carotid artery revealed by dysphonia and chronic cough.

Bilateral Retropharyngeal Internal Carotid Artery ‘Kissing Carotids’: A Case Report

Aberrant course of the internal carotid arteries is a rare congenital malformation, accounts for 5% of cases. Several cases of fatal hemorrhage due to an injury to the aberrant internal carotid artery have been observed in patients undergoing pharyngeal surgery procedures. This was associated with a lack of detection during surgery. We report a case of aberrant commun and internal carotid arteries, manifested by odynophagia. This particular anatomical condition should be suspected in patients with pharyngeal mass before any invasive procedure.

Transoral Surgery for Irreducible Atlantoaxial Dislocation Complicated by Concomitant Aberrant Internal Carotid Arteries.

Transoral Surgery for Irreducible Atlantoaxial Dislocation Complicated by Concomitant Aberrant Internal Carotid Arteries.

Analysis of Etiology, Diagnosis, and Treatment Strategy and Efficacy of Pulsatile Tinnitus Caused by Abnormal Vascular Anatomy.

To investigate the etiology, clinical characteristics, diagnosis, and treatment strategies and efficacy of pulsatile tinnitus (PT) caused by vascular anatomy abnormality. The clinical data of 45 patients with PT in our hospital from 2012 to 2019 were collected and retrospectively analyzed. All 45 patients had vascular anatomical abnormalities. The patients were divided into 10 categories according to the different locations of vascular abnormalities: sigmoid sinus diverticulum (SSD), sigmoid sinus wall dehiscence (SSWD), SSWD with high jugular bulb, pure dilated mastoid emissary vein, aberrant internal carotid artery (ICA) in the middle ear, transverse-sigmoid sinus (TSS) transition stenosis, TSS transition stenosis with SSD, persistent occipital sinus stenosis, petrous segment stenosis of ICA, and dural arteriovenous fistula. All patients complained of PT synchronous with heartbeat rhythm. Endovascular interventional therapy and extravascular open surgery were used according to the location of the vascular lesions. Tinnitus disappeared in 41 patients, was significantly relieved in 3 patients, and was unchanged in 1 patient postoperatively. Except for one patient with transient headache postoperatively, no obvious complications occurred. PT caused by vascular anatomy abnormalities can be identified by detailed medical history and physical and imaging examination. PT can be relieved or even completely alleviated after appropriate surgical treatments.

A Case of Aberrant Internal Carotid Artery Running Within the Tympanic Cavity Causing Hearing Loss

A Case of Aberrant Internal Carotid Artery Running Within the Tympanic Cavity Causing Hearing Loss

Symptoms: Purple Ear Drum and Hearing Loss

Symptoms: Purple Ear Drum and Hearing Loss

Hemangioma of temporal bone: clinical case

Vascular tumors often localized in the region of head and neck. Intraosseous hemangiomas localized mainly in the vertebrae and in the skull bones, but they are rarely found in the temporal bone. More often, intratemporal hemangiomas are localized in the internal auditory canal or in the area of the geniculate ganglion and Scarpas ganglion, due to the abundant blood supply of these areas. In other areas of the temporal bone, hemangioma is extremely rare. The symptoms depend on the localization and size of the tumor. The main clinical manifestations of the disease: facial nerve palsy, hemifacial spasm, cochleovestibular symptoms. The data of computed tomography (CT) and magnetic resonance imaging (MRI) are non-specific. Angiography is recommended to identify the anatomical features of the vessels like aberrant internal carotid artery, high jugular bulb), the blood supply of the tumor and the possibility of embolization, which significantly reduces the risk of bleeding and damage to important anatomical structures of the temporal bone during surgery. Differential diagnosis is carried out with many diseases of the temporal bone: cholesteatoma, glomus tumor, shwannoma of the VII and VIII cranial nerves, Langerhans cell histiocytosis, rhabdomyosarcoma, etc. Surgical treatment is the method of choice and allows to completely resect the tumor. The article presents a clinical case of intratemporal hemangioma in a patient with a long term symptom of hearing loss.

Unilateral Aberrant Internal Carotid Artery in the Middle Ear: A Case Report Presenting with Pulsatile Tinnitus

The prevalence of aberrant internal carotid artery (ICA) in the middle ear is very low. It represents a potentially life-threatening anatomical variation that requires an accurate diagnosis to prevent catastrophic complications such as massive hemorrhage during otologic procedures. Tomography and magnetic resonance could be very useful to identify this rare entity and to avoid its complications. We report the case of a 42-year-old woman who presented to our Ear, Nose and Throat department with persistent unilateral pulsatile tinnitus. An aberrant ICA in the tympanic cavity is a rare and particularly dangerous condition. Otolaryngologists must always consider the possibility of severe or fatal hemorrhage, so accurate pre- operative radiologic investigations are recommended before each middle-ear surgical intervention.

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

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.

Imaging of Aberrant Internal Carotid Arteries.

Aberrant internal carotid arteries (ICAs) may take abnormal courses in the cervical region. We present the ICA imaging features that suggest the presence of a submucosal mass in the posterior pharyngeal wall caused by such an aberration. Cervical computed tomography angiography images of 2400 patients obtained over 5 years were retrospectively reviewed. The ICA courses at the levels of the hypopharynx and oropharynx were evaluated. Aberrant ICAs running posterior to the pharynx were selected. Vessel location was classified into 3 types: lateral to the vertebral foramen (normal, type I); between the lateral foramen and the uncovertebral joint (type II); and medial to the uncovertebral joint (type III). Medical records were examined, and relationships between symptoms, the ICA variations, and imaging features evaluated. Cervically aberrant ICAs of type II were detected in 45 patients and aberrations of type III in 18. In the latter group, the mean patient age was 66 years, 12 were men and 6 were women. Six (33%) patients (4 men) had clinical symptoms associated with their aberrant ICA courses. In 2 men (11%), both ICAs took aberrant courses. Otherwise, the right ICA was affected in 9 (50%) cases and the left ICA in 7 (39%). Parapharyngeal ICA aberrations were both common and asymptomatic. Such ICAs may be damaged during pharyngeal surgery or intubation. The ICA location should be investigated before any interventional procedure.

Aberrant internal carotid artery in the middle ear

Aberrant internal carotid artery in the middle ear

Aberrant internal carotid artery in the oropharynx space poses a life-threatening risk of surgery.

Tortuosity of the internal carotid artery (ICA) is not a rare condition, but its clinical impact is underestimated. The differences in the course and shape of the ICA in the oropharynx just beneath the mucosa were investigated to determine the possible fatal bleeding for both major oropharyngeal tumor resection and less extensive procedures. We report two cases to reveal that the awareness of such an anatomical variation before performing oropharyngeal procedures. We report two different pathologies of retropharyngeal ICAs, which presented with otolaryngological symptoms. Case 1 Retropharyngeal right ICA. The vessel's minimum distance to the pharyngeal wall was 1mm (very high risk of vascular injury) with a tortuous pathway. Case 2 Retropharyngeal right ICA. A tortuous ICA was in contact with the posterior pharyngeal wall (very high risk of vascular injury). The otolaryngologists surgeons must use caution in evaluating patients with masses in the pharynx and augment a careful and complete head and neck examination with appropriate imaging studies before operating.

Right arch with prostaglandin-dependent coarctation and aberrant left carotid artery in a 22q11.2 deletion infant.

Right aortic arch in association with coarctation of the aorta and vascular ring is a rare anatomy. We present an infant with chromosome 22q11.2 deletion, who had the right aortic arch with retroesophageal aberrant left subclavian artery and left internal carotid artery. The left external carotid artery and right common carotid artery originated together from the ascending aorta as a bovine branch. The infant also had severe coarctation, which was prostaglandin dependent.

Non-inflammatory and non-neoplastic soft tissue lesions of the tympanic cavity

Objectives: Tympanic cavity (TC) is an anatomically challenging region for the diagnosis of lesions located inside it. Radiological diagnosis and demonstration of the anatomic localization of sporadic lesions such as vascular malformations and meningocele are essential for the prevention of complications that may occur during operation and recurrent unnecessary interventions. The aim of the present study was to demonstrate the radiological appearance of the vascular variations and the post-traumatic soft tissue lesions which are rarely encountered in TC. Methods: A total of 3525 temporal multi-slice computed tomography (MSCT) images were evaluated between 2010–2018. Twelve cases with non-inflamatory and non-neoplastic soft tissue lesions in TC were detected and 2 with meningocele were included in the study. Results: Of the 12 cases, 6 were males and 6 were females. The mean age of the patients was 26.16 years. Four cases had an aberrant internal carotid artery (ICA), being bilateral in 2 cases and right sided in the remaining 2 cases. Six cases had dehiscent mega jugular bulb (DMJB); and 2 cases had post-traumatic meningocele. Conclusion: Vascular malformations and meningoceles are rarely observed in TC. They may present nonspecific clinical signs and symptoms; however, they should be evaluated with MSCT and MRI before the surgical interventions regarding the middle ear to prevent possible complications.

Abstract WMP40: Cervical Internal Carotid Artery Tortuosity as a Marker of Non-Atherosclerotic Aging: Results From the Northern Manhattan Study (NOMAS)

Background: Cervical internal carotid artery (ICA) tortuosity has been associated with vascular risk and stroke as well as genetic disorders related to abnormal extracellular matrix remodeling. It is plausible that dystrophic or aberrant arterial remodeling may therefore relate to cervical ICA tortuosity. We hypothesized that cervical ICA tortuosity relates to carotid dilatation, but not to traditional ultrasound (US) markers of atherosclerosis. Methods: Subjects of the NOMAS with available time-of-flight MRA were included in our study. Cervical ICA tortuosity was defined as a bend in the distal cervical ICA of &gt; 90° as seen on MRA. We excluded subjects with &lt; 5 cm of the cervical ICA visualized. Distensibility was calculated as the percentage excursion of the right CCA diastolic diameter during systole, which was assessed by high-resolution B-mode US of the right common carotid artery (CCA). We used multivariable logistic regression analyses to estimate odds ratios for the association of cervical ICA tortuosity and Doppler measures of carotid wall aging. Results: We visualized cervical ICA tortuosity in 468 NOMAS participants (mean age 64±8 years, 70% women, 70% Hispanic). It was present in 23% of subjects. In unadjusted models, cervical ICA tortuosity was more common in women (OR 2.34, 95% CI 1.34-4.11), Hispanics (OR 1.85, 95%CI 1.06-3.25) and those with higher diastolic blood pressures (OR per mm Hg 1.04, 95%CI 1.01-1.06), and less common among smokers (OR 0.23, 95%CI 0.07-0.78). In models adjusted for demographic and vascular risks, right CCA tortuosity was associated with ipsilateral larger CCA DD (OR 1.42, 95%CI 1.02-1.96) and borderline associated with lower distensibility (OR 0.94, 95%CI 0.87-1.01, P=0.06) but not with ipsilateral ICA IMT (OR 0.26, 95%CI 0.14-4.77), number of plaques (OR 1.08, 95%CI 0.76-1.53), maximum plaque thickness (OR 0.96, 95%CI 0.73-1.27), or plaque area (1.00, 95%CI 0.97-1.05). Conclusions: Cervical ICA tortuosity associates with ipsilateral cervical ICA dilatation and lower distensibility, but not with traditional US markers of atherosclerosis. The association with diastolic blood pressure suggests a role of steady, rather than pulsatile, hemodynamics in aberrant cervical ICA remodeling.

Aberrant internal carotids artery presenting as an oropharyngeal mass

Aberrant internal carotid artery is a quite unusual condition that can cause a foreign body sensation in the throat. The case study is about a 49-year-old woman with dysphagia associated to a foreign body sensation in her throat, developed for the last weeks owing to aberrant retropharyngeal inte