Bilateral congenital absence of the internal carotid arteries: a case report

Abstract

Congenital absence of the internal carotid artery is a rare occurrence. Even more infrequent are cases where the patient has a bilateral absence of the internal carotid arteries. Reported is a case of a 52-year-old woman who presented with optic nerve neuropathy, and was incidentally discovered to have a congenital bilateral absence of her internal carotid arteries. During computed tomography angiography imaging looking for cerebral venous thrombosis, related to her preexisting condition of bilateral elevated optic discs and residual left optic neuropathy, the findings were made. The absence of the arteries is not always recognizably symptomatic, with most findings being incidental through imaging studies only. This is because collateral flow allows for sufficient cerebral circulation. However, this condition puts such patients at higher risk for conditions such as aneurysms and subsequently strokes where the collateral flow exists.

An Illustrative Case of Bilateral Internal Carotid Artery Occlusion Concomitant with Aneurysm of the Obstructed ICA Reconstituted via Collaterals: Emphasizing the Role of Rescue Collaterals in Decision-Making

“…Three major collateral pathways to the anterior cerebral circulation have been described, the most common of which is through the enlarged PCoAs. 4 Reversed flow through the ophthalmic artery and blood flow via leptomeningeal vessels are considered secondary collateral pathways. Two types of collateral circulation have been defined in our case of bilateral ICA occlusions, in which the ophthalmic artery supplies There are three anastomoses between the OA and the MMA as follows: the anastomotic branch with MMA, the recurrent meningeal branch, and the anterior falx artery.…”

“…The left ophthalmic artery is markedly dilated, and anastomotic vessels are seen well filled from the middle meningeal artery branches around the orbital region (►Figs. 4…”

Absent right internal carotid associated with posterior cerebral artery aneurysm: A case report

“…Imaging investigations like CT, MRI, carotid Doppler ultrasonography, or conventional as well as CT/MR angiography can be used to identify and detect the absence of the ICA [ 11 ].…”