Separate arch origin of the left external carotid artery with common trunk giving rise to the left internal carotid artery and left subclavian artery

We present a case of a 3-year-old boy with tetralogy of Fallot having the direct origin of the left external carotid artery from the aorta with a common trunk giving rise to the left internal carotid artery and left subclavian artery, in a right-sided aortic arch. We also highlight the potential implications in management.     

Complications associated with clamping the aorta between the left common carotid artery and left subclavian artery

BACKGROUND: Hypothermic circulatory arrest using a left thoracotomy has recently been recommended for repair of distal arch lesions to prevent the atheroembolism that often results from clamp injury. The recommendation holds even for cases in which aortic cross-clamping between the left common carotid artery and left subclavian artery is possible. METHODS: Over the last 16 years, 69 patients underwent repair of the distal arch or descending thoracic aorta using distal perfusion with the proximal aortic clamp placed between the left common carotid and left subclavian artery. The average age of the patients was 61+/-12 years; 18 of them (26%) were older than 70 years. Forty-four patients (64%) had atherosclerotic true aneurysms. RESULTS: The surgical procedures used included patch closure of saccular aneurysms in 20 patients (29%) and graft replacement in 47 (71%). The left subclavian artery was reattached in 7 patients (10%). Although there were 3 hospital deaths (4%), no cerebral complications occurred aside from temporary neurologic dysfunction in 4 patients (6%). CONCLUSIONS: An acceptably low incidence of cerebral complications is associated with cross-clamping the aorta between the left common carotid artery and left subclavian artery.     

Right coronary artery to left carotid artery collateral in the absence of stenosis

Anomalies as well as variations of vascular structures are widely diagnosed with today's advanced diagnostic tools and healthcare screening programs. Collateral formation is a well known phenomenon in the presence of stenosis or occlusion to provide blood flow to the distal vasculature. In this report, we present the image of a collateral between the left common carotid artery and right coronary artery in the absence of significant stenosis.     

Agenesis of the left internal carotid artery, common carotid artery, and main trunk of the external carotid artery associated with multiple cerebral aneurysms

A case of agenesis of the left internal carotid artery, common carotid artery, and the main trunk of the external carotid artery with multiple cerebral aneurysms is presented. This case was diagnosed by angiography and computed tomography scanning and confirmed by operation. Correlation between the anomaly of the circle of Willis based on the absence of the internal carotid artery and the development of cerebral aneurysm is discussed on the basis of the reported cases.     

Surgical treatment for traumatic transection of left common carotid artery

I njurytothesupraaorticarteryisarareevent,withpoorprognosisandhighmortality.1Improvementoftheoutcomemaylieonthecombinationofseveralaspects,includingbetterpre hospitalcare,useofemergencycardiopulmonarybypass(CPB),improvedsurgicaltechniquesandfacilities,andadvancedpostoperativeintensivecare.Someresearchersemphasizedtheimportanceofemergency CPBinthetreatmentandthoughtthatitwas responsiblemainlyfortheimprovedoutcome.2 6 However,thereexistscontroversiesaboutit.7 9Inthis article,wereportedthatapa…     

Agenesis of the left internal carotid artery, common carotid artery and main trunk of the external carotid artery associated with multiple cerebral aneurysms: case report

A case of agenesis of the left internal carotid artery, common carotid artery and main trunk of external carotid artery with multiple cerebral aneurysms is presented. No similar case has been reported before. A 70-year-old man who had severe headache was admitted to the neurological department of Matsuyama Shimin Hospital. On admission he demonstrated nuchal rigidity and motor aphasia. CT scan revealed subarachnoid hemorrhage with intracerebral hematoma in the left temporal area. Right common carotid angiography, bilateral retrograde brachial angiography and aortography demonstrated an agenesis of the left internal carotid artery, common carotid artery and main trunk of external carotid artery with aneurysms of the anterior communicating artery, left middle cerebral artery and basilar tip. And these revealed that the left middle cerebral artery was fed from the basilar artery via the dilated left posterior communicating artery, and the left ophthalmic artery was originated from the left middle cerebral artery. CT of the base of the skull revealed no carotid canal on the left side. We confirmed these findings by operation. The importance of altered hemodynamic forces on the circle of Willis produced by the agenesis of the internal carotid artery and the embryological considerations are discussed.     

Agenesis of the left internal carotid artery with an ophthalmic artery arising from the posterior communicating artery

A case of agenesis of left internal carotid artery is reported. The patient is a forty one-year-old house-wife with sudden episode of headache when she had a fever. CT scan of the head showed a small high density area in the right frontotemporal subcortical region. Four vessel cerebral angiography demonstrated negative lesion except for complete absence of the left internal carotid artery. The blood supply to the left cerebral hemisphere was provided both through the tortuous anterior communicating artery and through the enlarged left posterior communicating artery. Left ophthalmic artery arose from the left posterior communicating artery. The embryological developmental process of this kind of vascular anomaly as well as the relationship between intravascular hemodynamic stress and the induction of cerebral aneurysm were discussed in detail.     

Isolated left carotid artery in CHARGE association: diagnosis and repair

Isolation of the left carotid artery is extremely rare. We report a case of isolation of the left carotid artery with CHARGE association. Aortic arch abnormalities should be looked for in all children with CHARGE association. The technique of repair involved implantation of the isolated left carotid artery to the ascending aorta.     

Innominate arterial rupture distal to anomalous origin of left carotid artery

Isolated innominate arterial rupture from blunt trauma is rare. We present the case of a pregnant woman with an isolated injury to the innominate artery distal to an anomalous origin of the left common carotid artery. A safe operative technique is described.     

Traumatic aneurysm of the intrathoracic left carotid artery with cerebral embolization

The presentation and management of a young male patient with a traumatic aneurysm of the intrathoracic portion of the left common carotid artery from a football injury, complicated by cerebral embolization, is detailed. At operation 6 weeks afterward the aneurysm was isolated and ligated and the patient was discharged 19 days postoperation with plans for physical and speech rehabilitation. At 14 months a chronic subdural hematoma which caused some seizures was removed, and the patient's neurologic status is continuing to improve. This appears to be the first report of an isolated blunt injury to this branch of the aortic arch.     

Antegrade cerebral perfusion by axillary artery and left carotid artery inflow at moderate hypothermia.

Cerebral protection during hypothermic circulatory arrest was obtained by combining right carotid perfusion through the axillary artery with selective perfusion of the left common carotid artery in ten patients. We believe that the proposed technique offers several advantages. (1) The axillary artery is generally free from atherosclerosis. (2) It eliminates the risk of retrograde embolization. (3) It provides antegrade perfusion of the true lumen in aortic dissection. (4) Antegrade cerebral perfusion is never interrupted. (5) Bihemispheric perfusion is assured. (6) The risk of air embolysm during carotid cannulation is reduced.     

Spontaneous innominate and left common carotid artery dissection with bovine aortic arch

We describe a case of a 63-year-old woman who presented with spontaneous dissection of the innominate and left common carotid arteries arising from a common trunk, so-called “bovine aortic arch.” The entry tear was seen in the common trunk at the origin of the innominate artery with no dissection extending into the aortic arch or the ascending aorta. The dissection was resected and total arch replacement was performed considering the aortic wall fragility complicated by the dissection.     

Delayed postoperative nonembolic neurologic deficit after left internal carotid endarterectomy in presence of known contralateral carotid artery occlusion

Neurologic sequelae are known complications of carotid endarterectomy. The current overall perioperative stroke rate is 2-5% (1,2). The incidence of perioperative morbidity and mortality is increased in certain patient subgroups, including neurologically unstable patients and patients who have known contralateral common or internal carotid artery occlusion (3-9). We present the case of a patient who had known total right carotid artery occlusion and a known previous right cerebrovascular accident who sustained a contralateral deficit after a left internal carotid thromboendarterectomy with vein patch angioplasty.