Agenesis of the Left Internal Carotid Artery Associated with Right Anterior Cerebral Artery A1 Segment Bifurcation Aneurysm: A Case Report

Demirgil, B; Tuğcu, Betül; Günaldı, Ömür; Postalcı, Lütfi Şinasi; Günal, Murat; Tanrıverdi, Osman

doi:10.1055/s-2007-985364

Cited by 5 publications

(1 citation statement)

References 7 publications

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“…Our review yielded a total of 33 articles reporting 39 cases of unilateral ICA anomalies associated with Acom aneurysms, aside from the case we present in this article. [ 1 - 5 , 7 , 9 , 12 - 14 , 18 , 19 , 21 , 24 - 28 , 36 , 37 , 40 , 41 , 43 , 47 - 50 , 52 , 53 , 55 - 58 ] A table summary of the review is provided in the [ Appendix Table 1 ].…”

Section: Resultsmentioning

confidence: 99%

Unilateral absence of the internal carotid artery associated with anterior communicating artery aneurysms: Systematic review and a proposed management algorithm

Al-Khafaji

Al-Sharshahi

Lee

et al. 2020

Surgical Neurology International

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Background: Absence or hypoplasia of the internal carotid artery (ICA) is a rare congenital anomaly that is mostly unilateral and highly associated with other intracranial vascular anomalies, of which saccular aneurysm is the most common. Blood flow to the circulation of the affected side is maintained by collateral pathways, some of which include the anterior communicating artery (Acom) as part of their anatomy. Therefore, temporary clipping during microsurgery on Acom aneurysms in patients with unilateral ICA anomalies could jeopardize these collaterals and place the patient at risk of ischemic damage. In this paper, we review the literature on cases with a unilaterally absent ICA associated with Acom aneurysms and provide an illustrative case. Methods: We combined our experience of one case of a unilaterally absent ICA associated with an Acom aneurysm with the 33 existing publications on the same subject in the literature, for a total of 40 cases. We provide a detailed systematic literature review of this association of vascular anomalies, exploring different aspects regarding the collateral pathways and how they impact management strategies and propose a management algorithm to deal with such association. Results: The mean age was 48.2 ± 16.5 years. The aneurysmal rupture was the most common presentation (75%). Agenesis was observed in 70% of patients, followed by hypoplasia (20%) and, finally, aplasia (10%). Lie Type A was the most common pattern of collaterals (50%), with Types B and D being of almost equal proportions. Most aneurysms were located at the A1-Acom junction contralateral to the anomalous side (Fisher’s Exact test; P = 0.03). One case of temporary clipping was reported in the literature. Conclusion: Acom aneurysms in patients with unilateral ICA anomalies, given they are more commonly present contralaterally, could be of acquired etiology, warranting periodic screening in asymptomatic patients. Temporary clipping might be safe in patients with Type D collateral pattern, while those with Types A or B may require intraoperative rupture risk assessment and a tailored management plan to avoid disrupting collateral flow and causing ischemia.

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