1 - Departement of Neuroradiology, Hospital São José e Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central –Portugal
- Lisbon Stroke Summit, 24 e 25 Março 2023, Cascais
Background: Stroke is a leading cause of death and disability worldwide. Rapid diagnosis and appropriate intervention are crucial for better outcomes. Internal carotid artery (ICA) variants are not uncommon and can pose diagnostic and therapeutic challenges.
Objective: This pictorial review aims to summarize ICA variants, including epidemiology and associated clinical syndromes, and to discuss their relevance in stroke management, specifically, potential pitfalls and considerations for endovascular treatment planning.
Methods: We conducted a retrospective review of neuroimaging studies of patients with ICA variants. Cases included patients with a retropharyngeal course of the ICA, coiling, and kinking of the cervical ICA, aberrant course of the petrous segment of the ICA, duplication, agenesis, and hypoplasia of the ICA, dolichoectasia of the distal ICA, and persistent carotid-vertebrobasilar anastomoses. Clinical data and imaging findings were analyzed.
Results: Endovascular treatment success may be less likely in the presence of ICA tortuosity, which is more frequent in patients with underlying hypertension or atherosclerosis. In cases where the ICA takes a retropharyngeal course, there is an increased risk of hemorrhage during tracheal intubation. Duplication and aplasia may mimic or mask occlusion. During thrombectomy, persistent carotidvertebrobasilar anastomosis serve as an alternative pathway to access the posterior circulation.
Conclusion: This study highlights the importance of identifying and characterizing ICA variations to avoid diagnostic errors, ensure optimal treatment planning, and improve patient outcomes.
Keywords: . Internal carotid artery (ICA); Variants; Stroke; Imaging