Abstract
We report a case of a patient with right type I proatlantal intersegmental artery associated with right fetal posterior cerebral artery and absence of both vertebral arteries and of the left posterior communicating artery. We also describe the clinical relevance of these findings for this patient. A 56-year-old woman with vertigo and tinnitus underwent contrast enhanced Magnetic Resonance Angiography (MRA) of the supra-aortic arteries using a 1.5 Tesla scanner. Maximum intensity projection and volume rendering reconstructions were obtained. MRA demonstrated the persistence of an anastomotic artery between the right internal carotid artery and basilar artery, passing through the foramen magnum, suggesting a type I proatlantal intersegmental artery. The examination also showed the absence of both vertebral arteries and the presence of a right fetal-type posterior cerebral artery. To our knowledge, this is the first report of a type I proatlantal intersegmental artery associated with an omolateral fetal-type posterior cerebral artery and the absence of both vertebral arteries and of the left posterior communicating artery. This condition requires a watchful monitoring of the patient and has to be considered in case of surgical procedures of the carotid arteries.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Anderson RA, Sondheimer FK (1976) Rare carotid-vertebrobasilar anastomoses with notes on the differentiation between proatlantal and hypoglossal arteries. Neuroradiology 11:113–118
Bahsi YZ, Uysal H, Peker S et al (1993) Persistent primitive proatlantal intersegmental artery (proatlantal artery I) results in ‘top of the basilar’ syndrome. Stroke 24(12):2114–2117
Basekim CC, Silit E, Mutlu H et al (2004) Type I proatlantal artery with bilateral absence of the external carotid arteries. Am J Neuroradiol 25(9):1619–1621
Burger IM, Siclari F, Gregg L et al (2007) Bilateral segmental agenesis of the vertebrobasilar junction: developmental and angiographic anatomy. Am J Neuroradiol 28(10):2017–2022
Cohen JE, Grigoriadis S, Itshayek E (2011) Type II proatlantal artery (occipital subtype) with bilateral absence of the vertebral arteries. Clin Anat 24(8):950–952
Gumus T, Onal B, Ilgit ET (2004) Bilateral persistence of type 1 proatlantal arteries: report of a case and review of the literature. Am J Neuroradiol 25(9):1622–1624
Hutchinson NA, Miller JD (1970) Persistent proatlantal artery. J Neurol Neurosurg Psychiatry 33(4):524–527
Kolbinger R, Heindel W, Pawlik G et al (1993) Right proatlantal artery type 1, right internal carotid occlusion, and left internal carotid stenosis: case report and review of the literature. J Neurol Sci 117:232–239
Luh GY, Dean BL, Tomsick TA et al (1999) The persistent fetal carotid-vertebrobasilar anastomoses. Am J Roentgenol 172(5):1427–1432
Parkinson D, Reddy V, Ross RT (1979) Congenital anastomosis between the vertebral artery and internal carotid artery in the neck. Case report. J Neurosurg 51(5):697–699
Rao TS, Sethi PK (1975) Persistent proatlantal artery with carotid-vertebral anastomosis. Case report. J Neurosurg 43(4):499–501
Saito N, Uchino A, Ishihara S (2012) Complex anomalies of type 1 proatlantal intersegmental artery and aortic arch variations. Surg Radiol Anat Sep 13 (Epub ahead of print)
Sato H, Fujiwara S, Otabe K et al (1985) A case of persistent primitive proatlantal intersegmental artery (proatlantal artery I) with aneurysm—a case report. No Shinkei Geka 13(1):117–121
Tanaka H, Takahashi H, Ishijima B et al (1987) A case of transiet cerebral ischemia of the vertebrobasilar system caused by carotid ulcerative lesion and persistent proatlantal intersegmental artery: a case report. No Shinkei Geka 15(3):341–347
Tsukamoto S, Hori Y, Utsumi S et al (1981) Proatlantal intersegmental artery with absence of bilateral vertebral arteries. Case report. J Neurosurg 54(1):122–124
van Raamt AF, Mali WPTM, van Laar PJ et al (2006) The fetal variants of the circle of Willis and its influence on the cerebral collateral circulation. Cerebrovasc Dis 22:217–224
Vasovic L, Mojsilovic M, Andelkovic Z et al (2009) Proatlantal intersegmental artery: a review of normal and pathological features. Childs Nerv Syst 25(4):411–421
Vasovic L, Jovanovic I, Ugrenovic S et al (2012) Trigeminal artery: a review of normal and pathological features. Childs Nerv Syst 28(1):33–46
Woodcock RJ, Cloft HJ, Dion JE (2001) Bilateral type 1 proatlantal arteries with absence of vertebral arteries. Am J Neuroradiol 22(2):418–420
Conflict of interest
The authors declare that they have no conflicts of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Montechiari, M., Iadanza, A., Falini, A. et al. Monolateral type I proatlantal artery with bilateral absence of vertebral arteries: description of a case and review of the literature. Surg Radiol Anat 35, 863–865 (2013). https://doi.org/10.1007/s00276-013-1086-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00276-013-1086-4