Abstract
Purpose
Congenital external carotid-internal carotid artery (EC-ICA) anastomosis is a cervical arterial variation that was initially reported, based on anatomic dissection, from Japan in 2000. The purpose of this report is to show the characteristic radiological findings of this extremely rare cervical arterial variation.
Methods
We analyzed nine cases, including six previously reported cases and three cases that we recently experienced. Three of the six previously reported cases were from Japan, and the remaining three cases were from Korea. MR angiography (4), CT angiography (2), catheter angiography (2) and autopsy (1) were used as diagnostic modalities.
Results
The study population included eight men and one woman. Anastomosis was seen on the left side in seven cases and the right side in two cases, and it was located at the level of the C1/2-C2/3 intervertebral space. In all cases, ECA was larger than the ICA at the level of their origins. In four cases, the ICA was extremely small in caliber. In one case, the ICA may have been occluded postnatally, and its configuration was similar to that of the nonbifurcating cervical carotid artery (CCA). With the exception of this occluded case, the carotid bifurcation and EC-ICA anastomosis formed a large arterial ring in all cases.
Conclusion
EC-ICA anastomosis can be regarded as a variant of the nonbifurcating CCA because if the most proximal segment of the small ICA is occluded, nonbifurcating CCA may form. EC-ICA anastomosis is located between the C1/2-C2/3 intervertebral space and may be formed by the remnants of the proatlantal artery I.
Similar content being viewed by others
Data availability
Not applicable.
References
Hu CC, Lai YJ, Lai WJ (2018) Nonbifurcating carotid artery: a case report with a review of embryogenesis. Am J Case Rep 19:891–895. https://doi.org/10.12659/AJCR.910019
Kim CH, Cho YD, Kang HS, Kim JE, Jung SC, Ahn JH, Han MH (2015) Anomalous external carotid artery-internal carotid artery anastomosis in two patients with proximal internal carotid arterial remnants. Korean J Radiol 16:914–918. https://doi.org/10.3348/kjr.2015.16.4.914
Lasjaunias P, Théron J, Moret J (1978) The occipital artery. Anatomy–normal arteriographic aspects–embryological significance. Neuroradiology 15:31–37. https://doi.org/10.1007/BF00327443
Lee BH (2020) Anomalous external carotid-internal carotid artery anastomosis diagnosed by computed tomography angiography: a case report. Radiol Case Rep 15:1948–1953. https://doi.org/10.1016/j.radcr.2020.07.072
Nakai K, Kaji T, Uchino A, Kawauchi T, Tamura C, Otani N, Nawashiro H (2012) Congenital external carotid-internal carotid artery anastomosis associated with contralateral non-bifurcating cervical carotid artery. Neuroradiology 54:521–523. https://doi.org/10.1007/s00234-011-0956-x
Sasaki T, Nagashima H, Oya F, Satoh D, Kobayashi S (2013) Carotid artery stenting for atherosclerotic stenosis associated with non-bifurcating cervical carotid artery. Neurol Med Chir (Tokyo) 53:228–232. https://doi.org/10.2176/nmc.53.228
Suzuki T, Moriyama T, Moriwaki H, Yagihashi A, Yajima N, Takahashi G (2000) Anomalous artery directly connecting the external and internal carotid arteries. Ann Anat 182:59–63. https://doi.org/10.1016/S0940-9602(00)80122-3
Uchino A, Saito N (2020) Occipital artery arising from the cervical internal carotid artery at the level of the C2 vertebral body: three cases detected utilizing magnetic resonance angiography. Surg Radiol Anat 42:831–834. https://doi.org/10.1007/s00276-020-02460-4
Uchino A, Saito N, Watadani T (2013) Congenital external carotid-internal carotid artery anastomosis diagnosed by MR angiography. J Neuroimaging 23:96–97. https://doi.org/10.1111/j.1552-6569.2011.00613.x. (Epub 2011 Jun 23)
Uchino A, Saito N, Watadani T, Mizukoshi W, Nakajima R (2011) Nonbifurcating cervical carotid artery diagnosed by MR angiography. AJNR Am J Neuroradiol 32:1119–1122. https://doi.org/10.3174/ajnr.A2462
Funding
The authors did not receive support from any organization for the submitted work.
Author information
Authors and Affiliations
Contributions
AU carried out the study design and drafted the manuscript. AU, JS and YB reviewed the manuscript critically, and have read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no conflict of interests.
Ethical approval and consent to participate
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Consent for publication
The all three patients signed informed consent regarding publishing their data and figures.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Uchino, A., Suzuki, J. & Baba, Y. Congenital external carotid-internal carotid artery anastomosis: a report of three cases and literature review. Surg Radiol Anat 45, 995–998 (2023). https://doi.org/10.1007/s00276-023-03187-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00276-023-03187-8