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Pseudofenestration of the Cervical Internal Carotid Artery: A Pathologic Process that Simulates an Anatomic Variant

Philippe Gaillouda, Jeffrey Carpentera, Donald V. Hecka and Kieran J. Murphya

a From the Division of Interventional Neuroradiology, Johns Hopkins Medical Institutions, Baltimore, MD



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  		FIG 1. Case 1, a 59-year-old woman with a left ICA fenestration. DSA, left common carotid injection, oblique view. One limb of the fenestration shows a slight fusiform enlargement.

FIG 2. Case 2, a 52-year-old man with a left ICA fenestration. DSA, left common carotid injection, oblique view. Both limbs of the fenestrated segment show an irregular appearance with fusiform dilatation. Note also the dilatation of the terminal ICA.

FIG 3. Case 3, a 51-year-old woman with a left ICA fenestration. DSA, left common carotid injection, lateral view. Fenestration of the left ICA immediately above the carotid bulb, associated with a proximal kink. Note the irregular appearance of one of the fenestration limbs, with a small distal pseudoaneurysm. The location of the fenestration suggests a possible iatrogenic event during a previous selective ICA angiogram, which remained unconfirmed in view of absent documentation.

FIG 4. Case 4, a 74-year-old man with a right ICA fenestration. DSA, right common carotid injection, oblique view. Fenestration of the distal cervical ICA immediately below the skull base, with a very irregular, enlarged limb that suggested a fusiform ICA aneurysm at MR imaging. Note that the anomaly occurs in a sinuous segment of the ICA (ICA "coiling").

FIG 5. Case 5, a 41-year-old woman with a right ICA fenestration. DSA, right common carotid injection, oblique view. The two limbs of the fenestration have a slightly irregular contour. One of the limbs shows, after reconnecting to the main lumen, an upward-directed pseudoaneurysmal expansion.

FIG 6. Case 6, a 46-year-old woman with right ICA fenestration. DSA, right common carotid injection, oblique view. Fenestrated segment of the right ICA with marked irregularity of its two limbs. One limb, reduced in caliber, is aligned with the ICA and most likely represents the original ICA lumen. The other limb is excentric and enlarged. It shows, besides the proximal and distal connections to the main lumen, two additional bridges joining the other limb of the fenestration. As an anatomic variant, note the origin of the right ascending pharyngeal artery from the ICA.





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X