Aberrant ICA pearls

Krings T, Geibprasert S, Cruz JP, et al.  Neurovascular Anatomy in Interventional Neuroradiology: A Case based approach. New York, Thieme, 2015. pp. 13-16.

 

1.  In ICA agenesis, APhA reconstitutes in horizontal petrous segment to form "distal ICA" and tympanic artery entering skull through Jacobsen's canal. 

 

2. Symptoms may be absent, or include pulsatile tinnitus, conductive hearing loss,  or a pulsatile retrotympanic mass. 

 

3. It can mimic glomus tumor, otosclerosis or AVM.  A temporal bone CT can help differentiate as aberrant ICA can show absent vertical segment of carotid canal, and lateral swing called line of Lapowyker beyond vestibular line

 

4.  Persistent stapedial artery exists in 0.5 percent of population and can present as pulsatile mass in middle ear cavity with or without pulsatile tinnitus.  Its associated with absent foramen spinosum.  It appears as a vessel  from petrous ICA supplying the MMA.

 

Pearls about aberrant subclavian artery

Krings T, Geibprasert S, Cruz JP, et al.  Neurovascular Anatomy in Interventional Neuroradiology: A Case based approach. New York, Thieme, 2015. pp. 6-9

 

1.  Its usually a remnant of distal right dorsal aorta distal to left subclavian artery, crossing midline to irrigate right upper extremity

 

2.  Diverticulum of Komerell, an outpouching of right dorsal aorta, arises as it crosses the  esophagus that occasionally compresses the esophagus and causes dysphagia "dysphagia lusoria", nonspecific thoracic pain, compression of trachea with dyspnea, or arteriotracheal or arterioesophageal fistulas wityh hematemesis or hemoptysis (very rare).  Even rarer is subclavian steal of ARSA

 

3. It can be inferred from anterior displacement of esophagus in mediastinum

 

4.  May need to intervene through the left vertebral artery which can be difficult