Transitory ischemic attack associated with a rare fenestration of the cervical segment of the internal carotid artery: a case report.
Carotid artery disease
Magnetic resonance imaging
Neurovascular interventions
Stroke
Journal
Journal of medical case reports
ISSN: 1752-1947
Titre abrégé: J Med Case Rep
Pays: England
ID NLM: 101293382
Informations de publication
Date de publication:
15 Jan 2022
15 Jan 2022
Historique:
received:
20
10
2021
accepted:
09
12
2021
entrez:
15
1
2022
pubmed:
16
1
2022
medline:
19
1
2022
Statut:
epublish
Résumé
Fenestration of the cervical segment of the internal carotid artery is a very rare finding, and its origin is still not fully understood. Explanations of its genesis range from dissections leading to the fenestration to the more common interpretation as a developmental vascular variant. However, most reported cases were symptomatic and presented with dissections, where even endovascular treatment of the fenestration of the cervical segment of the internal carotid artery became necessary. Here we report a case of a fenestration of the cervical segment of the internal carotid artery suffering a transitory ischemic attack and local pain in absence of any sign of dissection. A 62-year-old Caucasian male patient was admitted to our institution because of an episode of amaurosis fugax, initially accompanied with headache. Magnetic resonance imaging revealed an intact fenestration of the cervical segment of the internal carotid artery on the symptomatic side. With antiplatelet therapy, all symptoms vanished within 2 months of the initial event. Our findings support the interpretation of a fenestration of the cervical segment of the internal carotid artery as a developmental vascular variant, but also suggest a substantial risk for dissection and ischemic stroke. Even in case of an accidental finding, clinicians should be aware of this. At least in this case, antiplatelet therapy seemed beneficial.
Sections du résumé
BACKGROUND
BACKGROUND
Fenestration of the cervical segment of the internal carotid artery is a very rare finding, and its origin is still not fully understood. Explanations of its genesis range from dissections leading to the fenestration to the more common interpretation as a developmental vascular variant. However, most reported cases were symptomatic and presented with dissections, where even endovascular treatment of the fenestration of the cervical segment of the internal carotid artery became necessary. Here we report a case of a fenestration of the cervical segment of the internal carotid artery suffering a transitory ischemic attack and local pain in absence of any sign of dissection.
CASE PRESENTATION
METHODS
A 62-year-old Caucasian male patient was admitted to our institution because of an episode of amaurosis fugax, initially accompanied with headache. Magnetic resonance imaging revealed an intact fenestration of the cervical segment of the internal carotid artery on the symptomatic side. With antiplatelet therapy, all symptoms vanished within 2 months of the initial event.
CONCLUSIONS
CONCLUSIONS
Our findings support the interpretation of a fenestration of the cervical segment of the internal carotid artery as a developmental vascular variant, but also suggest a substantial risk for dissection and ischemic stroke. Even in case of an accidental finding, clinicians should be aware of this. At least in this case, antiplatelet therapy seemed beneficial.
Identifiants
pubmed: 35031059
doi: 10.1186/s13256-021-03227-0
pii: 10.1186/s13256-021-03227-0
pmc: PMC8760826
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
13Commentaires et corrections
Type : ErratumIn
Informations de copyright
© 2021. The Author(s).
Références
Hasegawa T, Kashihara K, Ito H, Yamamoto S. Fenestration of the internal carotid artery. Surg Neurol. 1985;23:391–5.
doi: 10.1016/0090-3019(85)90214-9
Nakamura H, Yamada H, Nagao T, Fujita K, Tamaki N. Fenestration of the internal carotid artery associated with an ischemic attack–case report. Neurol Med Chir (Tokyo). 1993;33:306–8.
doi: 10.2176/nmc.33.306
Gailloud P, Carpenter J, Heck DV, Murphy KJ. Pseudofenestration of the cervical internal carotid artery: a pathologic process that simulates an anatomic variant. AJNR Am J Neuroradiol. 2004;25:421–4.
pubmed: 15037466
pmcid: 8158555
Zheng M, Liu X, Song Y, Zhang J, Han J. Rare fenestration of an occluded internal carotid artery treated with stenting. J Vasc Surg. 2020;72:319–20.
doi: 10.1016/j.jvs.2020.03.034
Mărginean L, Filep RC, Constantin C, Bălaşa AF, Mühlfay G. Fenestration of the cervical internal carotid artery misdiagnosed as dissection. Rom J Morphol Embryol. 2020;61:257–60.
doi: 10.47162/RJME.61.1.30
Koenigsberg RA, Zito JL, Patel M, Swartz JD, Goldofsky E, et al. Fenestration of the internal carotid artery: a rare mass of the hypotympanum associated with persistence of the stapedial artery. AJNR Am J Neuroradiol. 1995;16:908–10.
pubmed: 7611071
pmcid: 8332278
Padget DH. The development of the cranial arteries in the human embryo. Contrib Embryol. 1948;32:205–61.
Killien FC, Wyler AR, Cromwell LD. Duplication of the internal carotid artery. Neuroradiology. 1980;19:101–2.
doi: 10.1007/BF00342603
Ye D, Huang J, Wang S, Sheng S, Liu M. Cerebral arterial fenestration associated with stroke and other cerebrovascular diseases. NeuroReport. 2021;32:1279–86.
doi: 10.1097/WNR.0000000000001720
Ozdoba C, Sturzenegger M, Schroth G. Internal carotid artery dissection: MR imaging features and clinical-radiologic correlation. Radiology. 1996;199:191–8.
doi: 10.1148/radiology.199.1.8633145