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Segmental agenesis of the internal carotid artery: angiographic aspects with embryological discussion

Agénésie segmentaire de la carotide interne. Aspects angiographiques, discussion embryologique

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Summary

The embryology of the internal carotid artery (ICA) shows that this vessel comprises from origin to termination six segments, i.e. cervical, petrous, vertical cavernous, horizontal cavernous, clinoid and cisternal segments. Each of these segments displays a specific course and limits, defined by the origin of the following embryonic arteries: ventral pharyngeal hyoid, mandibular, primitive maxillary, trigeminal, dorsal ophthalmic and ventral ophthalmic. Each segment is independent and may show agenesis. In such cases the internal carotid blood flow (hemispheric arterial supply) is rerouted to afford usual ICA supply distal to the agenetic segment.

All congenital anomalies of the ICA can be described and understood on the basis of embryological data. The “aberrant internal carotid” can therefore be identified as a normal vessel. Differentiation can be made between congenital versus acquired absence of the ICA. This type of analysis should allow the clinician to recognize what are normal, albeit rare variations, rather than to mistake them for an abnormal condition requiring treatment.

Résumé

L'étude de l'embryologie de la carotide interne montre qu' on peut la scinder en six segments consécutifs: cervical, pétreux, caverneux vertical, caverneux horizontal, clinoïdien, cisternal. Chacun d'eux a un trajet et des limites fixes, marqués par l'origine de vaisseaux embryonnaires particuliers: pharyngée ventrale, hyostapédienne, mandibulaire, maxillaire primitive, trijéminée, ophtalmique dorsale, ophtalmique ventrale.

Chaque segment est indépendant et peut être agénétique; le flux carotidien est alors “dévié” par un autre chemin pour ce seul segment, après quoi, il retrouve la carotide interne stricto sensu dans son trajet habituel. Différentes agénésies segmentaires sont ainsi présentées: cervicale, pétreuse, caverneuse. Les “déviations” artérielles (cavité tympanique, fosse postérieure, côté opposé) et les vaisseaux embryonnaires objectivés (hyoïdienne, trijéminée, maxillaire primitive) permettent de caractériser de façon anatomiquement précise le défect artériel segmentaire et la solution hémodynamique qu'il a entraîné. On est dès lors capable de faire la différence entre une absence congénitale et acquise de la carotide interne, et celle qui sépare une disposition rare mais normale, prévisible et connue d'un aspect ignoré et considéré parfois à tort comme pathologique.

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Lasjaunias, P., Santoyo-Vazquez, A. Segmental agenesis of the internal carotid artery: angiographic aspects with embryological discussion. Anat. Clin 6, 133–141 (1984). https://doi.org/10.1007/BF01773165

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