Internal carotid artery agenesis associated with anterior communicating artery aneurysm: A rare case report
Main Article Content
Abstract
Internal carotid artery agenesis is an extremely rare congenital vascular anomaly that can alter cerebral hemodynamics and is associated with the formation and rupture of intracranial aneurysms. We report the case of a 35-year-old male patient with no significant past medical history, who presented with subarachnoid hemorrhage due to rupture of an anterior communicating artery aneurysm. Cerebrovascular imaging revealed absence of the left internal carotid artery, along with absence of the left carotid canal on skull base computed tomography and vascular reconstruction. Cerebral circulation was maintained through a combined type A and B collateral pattern according to the Lie classification, in which the left anterior cerebral artery was supplied via the anterior communicating artery, while the left middle cerebral artery received blood flow predominantly from the posterior circulation through the posterior communicating artery, with additional contribution from the anterior communicating artery. The patient underwent endovascular coiling. At one-month follow-up, the clinical status remained stable with no evidence of residual aneurysm on imaging.
Article Details
Keywords
Agenesis, internal carotid artery, aneurysm, stroke
References
2. Lee JH, Oh CW, Lee SH, Han DH. Aplasia of the internal carotid artery. Acta Neurochir (Wien). 2003;145(2):117-125. doi:10.1007/s00701-002-1046-y
3. Li S, Hooda K, Gupta N, Kumar Y. Internal carotid artery agenesis: A case report and review of literature. Neuroradiol J. 2017;30(2):186-191. doi:10.1177/1971400917692162
4. Akdemir Aktaş H, Farımaz M, Fırat A, Göçmen R. Rare congenital anomalies of the internal carotid artery: anatomic and radiologic aspects of three cases and review of the literature. Surg Radiol Anat. 2020;42(11):1363-1370. doi:10.1007/s00276-020-02549-w
5. A. LT, Hage J. Congenital anomalies of the carotid arteries. Plast Reconstr Surg. Published online 1968. doi:10.1097/00006534-196809000-00046
6. Oz II, Serifoglu I, Yazgan O, Erdem Z. Congenital absence of internal carotid artery with intercavernous anastomosis: Case report and systematic review of the literature. Interv Neuroradiol. 2016;22(4):473-480. doi:10.1177/1591019916641317
7. Paşaoğlu L, Vural M, Ziraman İ, Uyanιk SA. Left Internal Carotid Artery Agenesis Associated with Basilar and Left Vertebral Artery Aneurysm. J Clin Imaging Sci. 2011;1:60. doi:10.4103/2156-7514.91133
8. Soni TV, Patel S, Shah V, Deo MR, Kotadiya K. A Rare Complex Case Report: Bilateral Congenital Internal Carotid Artery Hypoplasia Associated with Ruptured Left True Posterior Communicating Artery Aneurysm. Asian J Neurosurg. 2024;19(03):567-571. doi:10.1055/s- 0044-1787861
9. Barbosa LG, Barbosa LA, Pimentel DP, Mata BEL, Guerra LR, Viana LS. Bilateral Agenesis of the Internal Carotid Artery Associated with Basilar Artery Aneurysm Treated via the Endovascular Route: A Case Report. Interv Neuroradiol. 2010;16(1):89-92. doi:10.1177/159101991001600112
10. Akturk Y, Conkbayir I, Kavak RP, Suer Dogan I. Rare congenital variations of the internal carotid artery identified incidentally: findings from CT angiography. Folia Morphol. Published online July 28, 2025:VM/OJS/J/105918. doi:10.5603/fm.105918
11. Ak A, Jc G, A M, Wr S, We B, Cg J. Cerebral hemiatrophy, hypoplasia of internal carotid artery, and intracranial aneurysm. A rare association occurring in an infant. Arch Neurol. 1987;44(2). doi:10.1001/archneur.1987.00520140090024
12. Quint DJ, Boulos RS, Spera TD. Congenital absence of the cervical and petrous internal carotid artery with intercavernous anastomosis. AJNR Am J Neuroradiol. 1989;10(2):435-439.
13. Al-Khafaji AO, Al-Sharshahi ZF, Lee RP, Alsubaihawi1 ZA, Dolachee AA, Hoz SS. Unilateral absence of the internal carotid artery associated with anterior communicating artery aneurysms: Systematic review and a proposed management algorithm. Surg Neurol Int. 2020;11:221. doi:10.25259/SNI_238_2020
14. Bonasia S, Smajda S, Ciccio G, Bojanowski MW, Robert T. Proposed new classification for internal carotid artery segmental agenesis based on embryologic and angiographic correlation. Surg Radiol Anat. 2023;45(4):375-387. doi:10.1007/s00276-023-03102-1
15. Hou D, Mei Y, Ji Y, et al. Congenital internal carotid artery hypoplasia: Case report. Medicine (Baltimore). 2019;98(1):e13986. doi:10.1097/MD.0000000000013986
16. Zhang P, Wang Z, Yu FX, et al. The clinical presentation and collateral pathway development of congenital absence of the internal carotid artery. J Vasc Surg. 2018;68(4):1054-1061. doi:10.1016/j.jvs.2018.01.043
17. Vasović L, Trandafilović M, Vlajković S, Radenković G. Congenital absence of the bilateral internal carotid artery: a review of the associated (ab)normalities from a newborn status to the eighth decade of life. Childs Nerv Syst. 2018;34(1):35-49. doi:10.1007/s00381-017-3629-1
18. Collado E, Bardoczi A, Lumsden AB, Garami Z. Internal Carotid Artery Hypoplasia Misidentified as Internal Carotid Artery Dissection. Methodist DeBakey Cardiovasc J. 2024;20(1):87-93. doi:10.14797/mdcvj.1417
19. Lasjaunias P, Santoyo-Vazquez A. Segmental agenesis of the internal carotid artery: angiographic aspects with embryological discussion. Anat Clin. 1984;6(2):133-141. doi:10.1007/BF01773165
20. Kiritsi O, Noussios G, Tsitas K, Lappas D. Unilateral agenesis of the internal carotid artery presented as transient ischaemic attack: a case report. Surg Radiol Anat. 2012;34(5):475-477. doi:10.1007/s00276-011-0901-z