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J Vasc Surg Cases Innov Tech
J Vasc Surg Cases Innov Tech
Journal of Vascular Surgery Cases, Innovations and Techniques
2468-4287
Elsevier

S2468-4287(24)00146-1
10.1016/j.jvscit.2024.101562
101562
Vascular Images
Bilateral internal carotid artery fenestration
Koh Ezra Y. MD ezra.y.koh@uth.tmc.edu
a
Ocasio Laura MD b
Macedo Thanila MD b
Keyhani Arash DO a
a Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center, Houston, TX
b Department of Radiology, University of Texas Health Science Center, Houston, TX
03 7 2024
10 2024
03 7 2024
10 5 10156212 4 2024
18 6 2024
© 2024 The Authors
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Key words

Internal carotid artery
Anatomic variant
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pmc

We present a case of bilateral internal carotid artery fenestration that was identified incidentally in a 72-year-old man. The patient had undergone a computed tomography angiogram of his neck to evaluate a thyroid nodule. The abnormality in the bilateral carotid arteries was noted and patient was referred to vascular surgery with concern for carotid dissection (A). The patient denied stroke symptoms and had no history of prior trauma. Review of the prior imaging showed symmetric duplication of the lumen in the distal extracranial internal carotid artery with smooth luminal contour on the right and irregular atherosclerotic plaque in one of the lumens on the left side (B/Cover and C). Given the incidental nature of the findings and absence of related symptoms, no intervention was indicated. The patients consented to the reporting of this case and sharing of images.

Carotid artery fenestrations are extremely rare anatomical variants that have been described previously.1 However, to our knowledge this case is the first in which this finding is present bilaterally. Although the term fenestration is often used interchangeably with duplication, these are in fact two distinct anatomical variants. Arteries with a single origin that divide into two separate lumens before reconverging are considered fenestrations, whereas arteries with separate origins which run in parallel courses are considered duplications. The development of these fenestrations is believed to be related to either the persistence of the carotid duct, an embryonic vessel which connects the third and fourth aortic ducts and usually regresses during development, or failure in fusion of complex arterial channels in the early stages of development.2 Their clinical significance is that they can appear radiographically very similar to dissections and may be mistaken for these. In the absence of symptoms, which could develop from stenosis or aneurysm, no treatment is indicated.

Illustration by David Factor.

Disclosures

None.

Appendix

Cover image

Appendix

Additional material for this article may be found online at www.jvscit.org.

The editors and reviewers of this article have no relevant financial relationships to disclose per the Journal policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest.

Additional material for this article may be found online at www.jvscit.org.
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References

1 Hacein-Bey L. Raghavan N. Mukundan G. Sekhon A.K. Dodrill L.K. Park T.C. Fenestration of the petrous internal carotid artery with short segment duplication mimicking an arterial dissection Clin Radiol 68 2013 972 975 23790690
2 Chess M.A. Barsotti J.B. Chang J.K. Ketonen L.M. Westesson P.L. Duplication of the extracranial internal carotid artery AJNR Am J Neuroradiol 16 1995 1545 1547 7484653
