Unusual anatomical variations of cervical and cranial arteries with surgical interest: case report

Abstract We report an exceptional case of a large right persistent proatlantal artery (PPPA), defined as a “mixed” type, because it originated as in Type 2 from the external carotid artery and courses as in Type1, i.e. over the vertebral artery groove of the posterior arch of C1, entering the skull...

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Main Authors: Monique Boukobza, Jean-Pierre Laissy
Format: Article
Language:English
Published: Sociedade Brasileira de Angiologia e de Cirurgia Vascular (SBACV) 2025-05-01
Series:Jornal Vascular Brasileiro
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Online Access:http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1677-54492025000100606&lng=en&tlng=en
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author Monique Boukobza
Jean-Pierre Laissy
author_facet Monique Boukobza
Jean-Pierre Laissy
author_sort Monique Boukobza
collection DOAJ
description Abstract We report an exceptional case of a large right persistent proatlantal artery (PPPA), defined as a “mixed” type, because it originated as in Type 2 from the external carotid artery and courses as in Type1, i.e. over the vertebral artery groove of the posterior arch of C1, entering the skull via the foramen magnum, without passing through the transverse foramen of any of the cervical vertebra. This “mixed” PPPA was associated first with an azygos anterior cerebral artery and second with a left common carotid artery arising from the brachiocephalic trunk. The right occipital artery arose from the PPPA. In addition, an aneurysm arose from the kinked right cervical internal carotid artery. This case illustrated an association not reported previously, making treatment of the concomitant aneurysm challenging. Moreover, understanding of persistent carotid-vertebral anastomosis is essential to enable evaluation and management before performing endovascular treatment, especially in cases of basilar thrombectomy and for posterior circulation strokes.
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spelling doaj-art-cfea76f75fdf42a8b7baf5c47faaed192025-08-20T02:24:22ZengSociedade Brasileira de Angiologia e de Cirurgia Vascular (SBACV)Jornal Vascular Brasileiro1677-73012025-05-012410.1590/1677-5449.202400482Unusual anatomical variations of cervical and cranial arteries with surgical interest: case reportMonique Boukobzahttps://orcid.org/0000-0002-8691-9004Jean-Pierre LaissyAbstract We report an exceptional case of a large right persistent proatlantal artery (PPPA), defined as a “mixed” type, because it originated as in Type 2 from the external carotid artery and courses as in Type1, i.e. over the vertebral artery groove of the posterior arch of C1, entering the skull via the foramen magnum, without passing through the transverse foramen of any of the cervical vertebra. This “mixed” PPPA was associated first with an azygos anterior cerebral artery and second with a left common carotid artery arising from the brachiocephalic trunk. The right occipital artery arose from the PPPA. In addition, an aneurysm arose from the kinked right cervical internal carotid artery. This case illustrated an association not reported previously, making treatment of the concomitant aneurysm challenging. Moreover, understanding of persistent carotid-vertebral anastomosis is essential to enable evaluation and management before performing endovascular treatment, especially in cases of basilar thrombectomy and for posterior circulation strokes.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1677-54492025000100606&lng=en&tlng=entype 2 persistent primitive proatlantal arteryleft common carotid artery variationextracranial internal carotid artery aneurysmvertebral artery hypoplasiakinkingazygos anterior cerebral artery
spellingShingle Monique Boukobza
Jean-Pierre Laissy
Unusual anatomical variations of cervical and cranial arteries with surgical interest: case report
Jornal Vascular Brasileiro
type 2 persistent primitive proatlantal artery
left common carotid artery variation
extracranial internal carotid artery aneurysm
vertebral artery hypoplasia
kinking
azygos anterior cerebral artery
title Unusual anatomical variations of cervical and cranial arteries with surgical interest: case report
title_full Unusual anatomical variations of cervical and cranial arteries with surgical interest: case report
title_fullStr Unusual anatomical variations of cervical and cranial arteries with surgical interest: case report
title_full_unstemmed Unusual anatomical variations of cervical and cranial arteries with surgical interest: case report
title_short Unusual anatomical variations of cervical and cranial arteries with surgical interest: case report
title_sort unusual anatomical variations of cervical and cranial arteries with surgical interest case report
topic type 2 persistent primitive proatlantal artery
left common carotid artery variation
extracranial internal carotid artery aneurysm
vertebral artery hypoplasia
kinking
azygos anterior cerebral artery
url http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1677-54492025000100606&lng=en&tlng=en
work_keys_str_mv AT moniqueboukobza unusualanatomicalvariationsofcervicalandcranialarterieswithsurgicalinterestcasereport
AT jeanpierrelaissy unusualanatomicalvariationsofcervicalandcranialarterieswithsurgicalinterestcasereport