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Summary
Extracranial anastomoses between the carotid and vertebrobasilar systems are rare compensatory pathways. This study highlights two unusual cases, demonstrating their diagnostic challenges and clinical significance in brain vascular circulation.
Area of Science:
- Neurology
- Vascular Surgery
- Radiology
Background:
- Extracranial anastomoses between the carotid and vertebrobasilar vascular beds are uncommon compensatory pathways for cerebral circulation.
- These can include primitive hypoglossal or proatlantal arteries, or smaller connections between the external carotid and vertebral arteries.
Observation:
- The study presents two distinct cases illustrating these rare anastomoses.
- Case 1: A 75-year-old male with vertebrobasilar insufficiency showed extensive filling of the vertebrobasilar system via common carotid artery puncture.
- Case 2: A 14-year-old female with aortic coarctation, hemiplegia, and internal carotid artery occlusion exhibited abnormal venous filling and vertebral artery filling, suggestive of an occipital-vertebral artery anastomosis.
Findings:
- Precise diagnosis of these anastomoses is challenging, often requiring selective catheterization or arcography.
- The presented cases demonstrate successful visualization of these rare collateral pathways under specific clinical conditions.
- Despite diagnostic difficulties, the findings suggest the presence of significant extracranial collateral circulation in certain cerebrovascular pathologies.
Implications:
- Understanding these rare anastomoses is crucial for accurate diagnosis and management of cerebrovascular diseases.
- These findings may influence treatment strategies for conditions like vertebrobasilar insufficiency and carotid artery occlusion.
- Further research into the prevalence and functional significance of these extracranial collaterals is warranted.