Open AccessCongenital Absence of Internal Carotid Artery with Rare Type of Intercavernous Anastamosis and Ruptured Cerebral Aneurysm
Author(s) -
Anand Alurkar,
Lakshmi Sudha Prasanna Karanam,
Sagar Oak,
Smita Kori
Publication year - 2016
Publication title -
journal of clinical and diagnostic research
Language(s) - English
Resource type - Journals
eISSN - 2249-782X
pISSN - 0973-709X
DOI - 10.7860/jcdr/2016/17797.7549
Subject(s) - medicine , internal carotid artery , aneurysm , collateral circulation , radiology , subarachnoid hemorrhage , anastomosis , occlusion , stenosis , clipping (morphology) , middle cerebral artery , surgery , cardiology , ischemia , philosophy , linguistics
Congenital absence of Internal Carotid Artery (ICA) is a rare anomaly seen in <0.01% of the population. Various collateral circulations develop in these cases to maintain adequate cerebral perfusion. High incidence of aneurysms is reported in these cases. Complete evaluation is required to detect other abnormalities usually seen in these patients. We report a case of congenital absence of right ICA in a 39-year-old female who presented with Subarachnoid Haemorrhage (SAH) and had a Middle Cerebral Artery Aneurysm (MCA). The right MCA got supply from the intercavernous communication from the left internal carotid artery. Skull base Computed Tomogram (CT) confirmed the congenital absence of right ICA. She underwent successful surgical clipping for the aneurysm. The high incidence of aneurysms, collateral circulations, embryological development and postulated mechanisms of this anomaly were discussed. The exact aetiology behind the absence of ICA remains unclear. It is important to differentiate this condition from acquired stenosis/occlusion due to atherosclerosis and carotid dissection. Recognising the anomaly is important and gains even more significance during surgical planning in cases of direct aneurysm clipping, carotid endarterectomy and transphenoidal surgeries.