Isolation of Left Common Carotid Artery with Its Origin Proximal to Patent Ductus Arteriosus Presenting in Adult Age

Abstract

Anomalies of aortic arch are a common occurrence. Such anomalies of right sided aortic arch with its various branching patterns are of clinical importance. Rarer anomalies include isolation (deficient connection) of either left subclavian artery or left common carotid artery; that is, they do not have their origin from aorta or its major branches. We present a case of an 18-year-old male who presented with gradual onset pulsatile swelling with bruit in neck on left side and was evaluated by CT brain and neck angiography. CT angiography revealed right sided aortic arch with aberrant left subclavian artery and isolated left common carotid artery. Very few cases of such an anomaly have been documented in the literature but none in an adult.

Isolated left common carotid artery: multidisciplinary management is the key to success

“…Isolation of the carotid artery is a rare form of aortic arch anomaly, with only 15 cases reported thus far (Table 1). [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] All except one case had a right aortic arch with an isolated left carotid artery. 14 In three patients, only the internal carotid artery was isolated, and the external carotid artery was arising from the aorta (8,11,14).…”

“…However, the presence of independent ipsilateral arterial duct or ductal ligament in 9 out of 15 reported cases (60%) as well as in the index case makes the connection between isolated carotid artery with the pulmonary artery unlikely to be via an arterial duct. 3,7,9,10,[12][13][14][15][16] Some authors have proposed an alternative hypothesis of malseptation of the trunco-aortic sac to explain the isolation of the aortic arch artery, especially the carotid artery. 6,9,16,19 Although not reported previously, the coexistence of anomalous origin of right coronary artery from the isolated left common carotid artery in our case also favours the theory of malseptation of the trunco-aortic sac (Fig 9).…”

“…4,6,7,9,11,16 Nonetheless, in 4 patients, the lower end of the isolated carotid artery was closed (Table 1). 2,3,13,15 Although the lower end of the isolated carotid artery can be closed using an occluder device, surgical ligation is preferred as it would also permit ligation and release of arterial duct or ductal ligament. 14 Two infants underwent concomitant aorta-pulmonary shunt for TOF/ pulmonary atresia.…”

“…The isolated carotid artery is the rarest form of arch vessel isolation, with only 15 cases reported thus far. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Surgical reimplantation of the isolated carotid artery is the preferred option. Nonetheless, the risk of post-operative cerebral hyperperfusion syndrome mandates careful preoperative evaluation and perioperative management.…”