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Radiologic anatomy of segmental agenesis of the internal carotid artery

Anatomie radiologique des agénésies segmentaires de l'artère carotide interne

Surgical and Radiologic Anatomy Aims and scope Submit manuscript

Summary

We report six cases of segmental agenesis of the internal carotid a. discovered in adult patients: one case of cervical segmental agenesis (no. 1), one case of cervical and petrosal segmental agenesis (no. 2), two cases of vertical cavernous segmental agenesis (nos. 3 and 4) and two cases of distal segmental agenesis, one unilateral (no. 5) and the other bilateral (no. 6). The collateral pathways observed were: the ascending pharyngeal a. which constitutes an “intratympanic course” of the internal carotid a. (no. 1), an intercarotid anastomosis (no. 2), an arterial network at the base of the skull, the so-called “rete mirabile” (nos. 3 and 4) and the posterior communicating a. (nos. 5 and 6). Recognition of these rare dysgeneses relies upon the following radio-anatomic characteristics: reduced caliber of the a., inconsistent sparing of the carotid body, reduced diameter or even absence of the carotid canal and above all, the presence of collateral pathways. The collateral pathways allow an understanding of the segmental nature of carotid a. development and a distinction between congenital and acquired stenoses.

Résumé

Six observations d'agénésies segmentaires de l'artère carotide interne, découvertes chez l'adulte, sont rapportées : un cas d'agénésie du segment cervical (no 1), un cas d'agénésie des segments cervical et pétreux (no 2), deux cas d'agénésie du segment caverneux vertical (no 3 et 4) et deux cas d'agénésie distale de l'artère, unilatérale (no 5) et bilatérale (no 6). Les voies de suppléance observées sont : l'artère pharyngienne ascendante réalisant un “trajet intratympanique” de l'artère carotide interne (no 1), une anastomose intercarotidienne (no 2), un réseau artériel de la base du crâne, dit “réseau admirable” (no 3 et 4) et l'artère communicante postérieure (no 5 et 6). La reconnaissance de ces rares dysgénésies repose sur les caractéristiques radio-anatomiques suivantes : réduction de calibre de l'artère, respect inconstant de sa portion bulbaire, réduction des dimensions voire absence du canal carotidien et surtout voies anastomotiques utilisées. Les anastomoses observées permettent en effet de comprendre le caractère segmentaire du développement de l'artère et de distinguer les sténoses congénitales et les sténoses acquises.

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Meder, J.F., Blustajn, J., Trystram, D. et al. Radiologic anatomy of segmental agenesis of the internal carotid artery. Surg Radiol Anat 19, 385–394 (1997). https://doi.org/10.1007/BF01628506

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