Anomalous Cervical External Carotid Artery-Internal Carotid Artery Anastomosis Diagnosed Using Digital Subtraction Angiography: A Case Report

Anomalous external carotid artery (ECA)-internal carotid artery (ICA) anastomosis is a rare variant of cervical carotid artery formation that forms an arterial ring in the cervical segment, and its embryological mechanism is still unknown. We report a case of a 41-year-old woman who was incidentally diagnosed with this arterial variation using digital subtraction angiography. The angiography revealed the occipital artery arising from the anastomotic vessel and the ascending pharyngeal artery arising from the ICA near the anastomosis. The proximal ICA was smaller in diameter than the proximal ECA, but it was not stenotic and had sufficient caliber for the distal blood flow. It is commonly believed that the persistence of primitive vessels is the result of agenesis or hypoplasia of the proximal artery. In our case, the anomalous vessel was considered to be the remnant of a primitive anastomosis between the ECA and the ICA via the pharyngo-occipital system, and the narrowing of the proximal ICA may be the result of the remaining ECA-ICA anastomosis.