A rare case of dual origin of the left vertebral artery without convergence

Abstract

A case of dual origin of the left vertebral artery was encountered in a dissection course for medical students in 2014. Two vertebral arteries were observed on the left side. One arose from the aortic arch between the origin of the left common carotid artery and the left subclavian artery, entered the transverse foramen of the 4th cervical vertebra, and coursed upward into the transverse foramen. The other arose from the left subclavian artery as expected, divided into two branches anterior to the cervical vertebrae, and entered the transverse foramina of the 6th and 7th cervical vertebrae. Both branches flowed into the anterior spinal artery. Moreover, as seen in other anomalies, 3 arterial fenestrations were observed in the cranial arteries. This case is extremely unique with respect to the following points: the 2 ipsilateral vertebral arteries did not combine to form 1 vertebral artery, the vertebral artery of subclavian artery origin entered the transverse foramen of the 7th cervical vertebra, and 3 fenestrations were observed in the intracranial arteries. This is a very suggestive case for neurosurgeons and radiologists who perform treatments involving the vertebral artery.

Two cases of dual origin left vertebral arteries with non-convergence

“…Thus, the vessel serving the brain is the persistent metameric vessel and the typically-developing VA is identified as the dual origin variant. However, unlike most reported cases (but see) [10], we could not identify a joining of the two vessels. It appears that the VA of SCA origin ends as branches serving the C5 and C4 vertebrae just proximal to the entrance of the vessel of AA origin in both cases.…”

Five Cases of an Accessory Left Vertebral Artery on the Aortic Arch

“…The left dorsal aorta creates the AA between the ductus arteriosus and the LSA. The fused right and left dorsal aortae create the AA distal to the left subclavian artery (Figure 11) [11,32,42,46]. The VAs arise between embryonic days 33 and 35 [7] by the fusion of the postcostal longitudinal anastomoses that link the cervical intersegmental arteries.…”

“…Knowledge of the potential patterns of variant origins for VAs is extremely important when performing both diagnostic and interventional angiography, thoracic surgeries, neurosurgeries, and cardiac catheterization procedures [1,4,26,38,39,46]. Such knowledge is even more essential in today's era of carotid and vertebral artery stent placements and new therapeutic options for intracranial interventions [4,13,32]. In addition, it is also clinically significant to be aware of VA variations, specifically accessory VAs, since they can be mistaken for a dissection of the VA [3,10,13,22].…”

A Case of Duplicated Right Vertebral Artery

“…A total of 52 cases of this type of artery have been reported in the English literature, including this case [5][6][7][8][9][10][11][12][13][14][15][16][17][18], but not including cases that were described vaguely in the 19th century [4]. A summary of the cases is as follows.…”