Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.202400482
Jornal Vascular Brasileiro
Case Report

Unusual anatomical variations of cervical and cranial arteries with surgical interest: case report

Variações anatômicas invulgares das artérias cervicais e cranianas com interesse cirúrgico: relato de caso

Monique Boukobza; Jean-Pierre Laissy

http://dx.doi.org/10.1590/1677-5449.202400482 J Vasc Bras, vol.24, e20240048, 2025
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Abstract

We report an exceptional case of a large right persistent proatlantal artery (PPPA), defined as a “mixed” type, because it originated as in Type 2 from the external carotid artery and courses as in Type1, i.e. over the vertebral artery groove of the posterior arch of C1, entering the skull via the foramen magnum, without passing through the transverse foramen of any of the cervical vertebra. This “mixed” PPPA was associated first with an azygos anterior cerebral artery and second with a left common carotid artery arising from the brachiocephalic trunk. The right occipital artery arose from the PPPA. In addition, an aneurysm arose from the kinked right cervical internal carotid artery. This case illustrated an association not reported previously, making treatment of the concomitant aneurysm challenging. Moreover, understanding of persistent carotid-vertebral anastomosis is essential to enable evaluation and management before performing endovascular treatment, especially in cases of basilar thrombectomy and for posterior circulation strokes.

Keywords

type 2 persistent primitive proatlantal artery; left common carotid artery variation; extracranial internal carotid artery aneurysm; vertebral artery hypoplasia; kinking; azygos anterior cerebral artery

Resumo

Relatamos um caso excepcional de uma grande artéria proatlantal persistente (APP) direita de tipo “misto”, pois origina-se como tipo 2 da artéria carótida externa e segue como tipo 1, ou seja, passa sobre o sulco da artéria vertebral no arco posterior de C1, entrando no crânio através do forame magno, sem atravessar o forame transverso de qualquer vértebra cervical. A APP “mista” foi associada, em primeiro lugar, a uma artéria cerebral anterior ázigo e, em segundo, a uma artéria carótida comum esquerda proveniente do tronco braquiocefálico. A artéria occipital direita originou-se da APP2. Além disso, um aneurisma surgiu da artéria carótida interna cervical direita dolicho. Este caso revela uma associação inédita, o que representa um desafio no tratamento do aneurisma concomitante. A compreensão da anastomose carótida-vertebral persistente é essencial para a avaliação e manejo antes de um tratamento endovascular, especialmente em casos de trombectomia basilar e de acidentes vasculares cerebrais na circulação posterior.

Palavras-chave

artéria proatlantal primitiva persistente tipo 2; variação da artéria carótida comum esquerda; aneurisma extracraniano da artéria carótida interna; hipoplasia da artéria vertebral; torção; artéria cerebral ázigos anterior

References

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Submitted date:
05/11/2024

Accepted date:
01/29/2025

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
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