Posterior Cerebral Circulation Insufficiency Due to Internal Carotid Artery Stenosis With an Atypical Vertebral Artery Originating From the Internal Carotid Artery Territory

Cureus, 2024 · DOI: 10.7759/cureus.75972 · Published: December 18, 2024

Cardiovascular Science Physiology Medical Imaging

Simple Explanation

This case report describes a rare instance of a vertebral artery (VA) originating from the internal carotid artery (ICA). This is significant because if the ICA becomes diseased, it can lead to neurological deficits. The patient presented with symptoms of intermittent dizziness, left facial numbness, and left arm paresthesia. Imaging revealed a dominant right VA arising from the right ICA and severe stenosis in the right ICA. The patient underwent a carotid endarterectomy and recovered well, with resolution of her symptoms. This highlights the importance of thorough investigation in patients with carotid artery stenosis and posterior circulation symptoms.

Study Duration

Not specified

Participants

One 76-year-old female

Evidence Level

Case Report

Key Findings

1
A dominant right vertebral artery was found to originate from the right internal carotid artery in a 76-year-old female.
2
The patient had a 70% stenosis in the right internal carotid artery origin.
3
Carotid endarterectomy with patch repair resolved both anterior and posterior circulation symptoms.

Research Summary

The case report highlights a rare anatomical variation where the vertebral artery originates from the internal carotid artery, potentially leading to posterior circulation neurological deficits if the ICA is diseased. A 76-year-old female presented with symptoms suggestive of both anterior and posterior circulation issues and was found to have a dominant right VA originating from the right ICA with significant ICA stenosis. The patient underwent successful carotid endarterectomy, emphasizing the importance of thorough investigation with CTA to identify such anatomical variations before treatment planning.

Practical Implications

Diagnostic Importance

High-quality imaging, such as CTA, is crucial for identifying aberrant vertebral artery anatomy in patients with carotid artery stenosis and posterior circulation symptoms.

Surgical Planning

Awareness of atypical vertebral artery origins is essential for vascular surgeons to minimize the risk of iatrogenic injuries during carotid artery surgeries.

Treatment Strategy

Carotid endarterectomy can be an effective treatment for patients with ICA stenosis and aberrant VA origin, resolving both anterior and posterior circulation symptoms.

Study Limitations

1
Single case report limits generalizability.
2
Duplex scan is unlikely to discover such aberrant anatomy.
3
Literature review revealed only three published reports of a VA originating from the ICA.

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