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Introduction Hypoplasia of the internal carotid artery (ICA) is incomplete development of the ICA with the presence of empty carotid canal. Despite anecdotal data reporting less than a 0.01% of developmental anomalies of ICA, the true incidence remains unknown. Many cases are asymptomatic and thus escape diagnostic detection or appropriate intervention. In 1968, Lie and Hage described collateral circulation in ICA developmental anomalies through the Circle of Willis, persistent embryonic vessels, or skull base arteries/anastomosis or rete mirabile. While collateral systems exist, subsequent cerebrovascular insufficiency and vascular malformations may occur as a result. To our knowledge, there is an incomplete body of literature surrounding the implications of ICA hypoplasia of varying anatomy. Methods We present a case report of left ICA hypoplasia and a comprehensive literature review. Results A 70‐year‐old woman with hypertension, nicotine dependence, and chronic obstructive pulmonary disease (COPD) presented with COPD exacerbation and disorientation. Computed tomography (CT) head angiography showing left cervical/petrous ICA aplasia with presence of a small carotid canal. The left external carotid and vertebral artery originate at the aortic arch. Majority of the blood supply to the left anterior cerebral artery (ACA) and middle cerebral artery (MCA) is suppliedby the right anterior communicating artery (AComA), posterior communicating artery (PComA). There is also a small left supraclinoid and carotid terminus that reconstitute predominantly by right A1 segment and PComA (Figure 1). Conclusions Although ICA hypoplasia may be an incidental finding, accurate and promptrecognition is essential for the consideration of endovascular implications, screening for vascular malformations, understanding cerebral vascular flow, managing cerebrovascular risk, and avoiding misinterpretation of clinical and imaging patterns.

Introduction Anterior choroidal artery (AChA) aneurysms account for 3–5% of intracranial aneurysms, and are often saccular, arising at or near the origin of the AChA, with distal lesions being exceedingly rare. Contrary to saccular aneurysms, fusiform aneurysms are associated with a higher risk of rebleeding and mortality due to their formidable anatomy requiring advanced techniques including bypass, stent‐assisted coiling, and, more recently, flow diversion. While flow diverters are becoming more popular, they are currently only approved forinternal carotid artery segment aneurysms. However, many institutions areexpanding their use to more distal and smaller caliber vessels. Herein we present a novel pathology of a dissecting distal AChA fusiform pseudoaneurysm with a small vessel caliber treated successfully with flow diversion. Methods Case presentation and surgical technique. Results We describe a 40‐year‐old woman with monoclonal gammopathy of unknown significance (MGUS), lichen sclerosis, and an unspecified connective tissue disease presenting with diffuse subarachnoid hemorrhage (SAH) (World Federation of Neurosurgical Societies 1; Hunt & Hess scale 2; Modified Fisher Scale 3). A digital subtraction cerebral angiogram revealed a dissecting (5×3 mm) left AChA pseudoaneurysm, 4mm distal to the origin (Figure 1). Flow Redirection Endoluminal Device (FRED Jr, Microvention, CA) (2.5mm 8/13 working/total length) was deployed within the vessel proximal to the aneurysm, preceded by an infusion of 5mg of verapamil to facilitate stent placement (Figure 2). Post procedure, she remained neurologically intact and was discharged on dual antiplatelet therapy (aspirin/ticagrelor). Repeat cerebral angiogram at six months showed patent flow diversion device and no pseudoaneurysm remnant (Figure 3) with a nonfocal physical examination. Conclusions Flow diversion may be a successful, and safe, therapeutic intervention for challenging distal intracranial aneurysms with smaller caliber vessels.

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Introduction: Stroke is the second leading cause of death worldwide, with more than a third of these deaths occurring in low-middle income countries, including most of Latin America (LATAM). However, the stroke care systems in LATAM are limited compared to high-income countries. Telestroke is an electronic communication system to deliver medical services from one site to another. Despite the optimal results increasing intravenous thrombolysis and endovascular therapy rates, its use in LATAM is scarce. Objective: The study aims to describe the current state of telemedicine (TM) and telestroke (TS) clinical applications in LATAM. Methodology: We conducted a systematic review of the literature according to PRISMA guidelines in PubMed/MEDLINE, Cochrane-Library, and Google-Scholar. The search was limited to English/Spanish languages using the search terms “telemedicine,” “telehealth,” “teleneurology,” “telestroke,” “Latin America.” In addition, we included randomized control trials, meta-analyses, observational cohorts, and literature reviews. Results: We identified 1,396 articles. After the screening and assessment for eligibility, 37 articles satisfied the inclusion criteria and revealed mixed results. The search showed that TM is widely used in different internal medicine subspecialties in LATAM than TS in Neurology. For example, the term “telemedicine” revealed 1,149 articles, and “telestroke” only 170 articles. Most of the articles reported the feasibility of TS (n=35), but the controlled comparison of TS with conventional services was barely reported (n=2). Brazil (n=7), Chile (n=4), Colombia (n=7), and Mexico (n=4) are the countries with the highest number of TS publications in LATAM. Conclusions: The use of TS is underdeveloped in LATAM compared to TM. Therefore, the collaboration of health authorities and non-governmental institutions is essential to continue building stroke care systems with TS in LATAM.