Carotid endarterectomy in rare bilateral carotid-vertebral anastomosis

In the embryo, the anterior and the posterior cerebral circulations are connected by several longitudinal anastomotic vessels. These anastomoses disappear progressively, until the carotid and vertebrobasilar systems are connected only by a pair of posterior communicating arteries. These embryonal anastomoses rarely persist in adults and may have an important physiologic role during carotid surgery. We report a case in which a patient with bilateral embryonal carotid-vertebral anastomoses underwent right carotid endarterectomy for asymptomatic internal carotid stenosis.