title: [Internal carotid artery stenosis and external carotid artery occlusion with unusual extracranial collateral pathway: case report].
abstract: A patient with stenosis of the internal carotid artery and occlusion of the external carotid artery associated with an unusual extracranial collateral pathway is presented. A 63-year-old man was hospitalized for sudden onset of black-out after urination. He was alert, and no neurological deficit was found. MRI showed multiple lacunae in the bilateral putamens. Cerebral angiogram demonstrated severe stenosis of the left internal carotid artery at its cervical segment and complete occlusion of the left external carotid artery at its origin. The ascending pharyngeal artery originated from the left internal carotid artery above its stenotic lesion and the superior thyroid artery originated from the left common carotid artery. The sternocleidomastoid branch from the left superior thyroid artery and the muscular branch from the left vertebral artery anastomosed with the muscular branch of the ascending pharyngeal artery. The ascending pharyngeal artery maintained patency of the internal carotid artery. It is important to perform vertebral angiography when there is proximal occlusion and severe stenosis of the internal carotid artery, and when the ascending pharyngeal artery has not been clearly identified as a branch from the ipsilateral external carotid artery on the common carotid angiogram.
authors.affiliation: Okawara Neurosurgical Hospital, Muroran, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Ueda
authors.forename: K
authors.initials: K
authors.lastname: Morinaga
authors.forename: Y
authors.initials: Y
authors.lastname: Matsumoto
authors.forename: N
authors.initials: N
authors.lastname: Omiya
authors.forename: J
authors.initials: J
authors.lastname: Mikami
authors.forename: H
authors.initials: H
authors.lastname: Satou
authors.forename: Y
authors.initials: Y
authors.lastname: Inoue
authors.forename: S
authors.initials: S
authors.lastname: Okawara
authors.forename: K
authors.initials: K
authors.lastname: Miyasaka
mesh_terms: D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D002342:Carotid Artery, External; D002343:Carotid Artery, Internal; D002560:Cerebrovascular Circulation; D003097:Collateral Circulation; D003251:Constriction, Pathologic; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012886:Skull