Department of Radiology, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, Thessaloniki, Greece.
2nd Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece.
Surg Radiol Anat. 2024 Oct;46(10):1659-1662. doi: 10.1007/s00276-024-03457-z. Epub 2024 Aug 13.
To highlight the clinical and diagnostic importance of correctly identifying cervical internal carotid artery fenestration (fcICA), an extremely rare vascular anomaly, and to present a case where fcICA was initially misdiagnosed as a dissection in a patient with fibromuscular dysplasia (FMD).
A 47-year-old woman with pulsatile tinnitus underwent computed tomography angiography (CTA) and digital subtraction angiography (DSA) to differentiate between fenestration and dissection of the internal carotid artery.
CTA revealed a fusiform dilatation of the distal C1 segment of the right internal carotid artery (ICA) with a linear filling defect, suggesting either fenestration or dissection. DSA confirmed the presence of a fenestrated right ICA segment composed of two symmetrical, smooth-walled limbs without a dissection flap, along with signs of FMD in the proximal vessel. The patient's symptoms were attributed to local flow perturbations induced by fcICA and FMD.
This case illustrates that fcICA can be a true anatomical variant rather than a result of dissection, emphasizing the need for accurate imaging and diagnosis to avoid unnecessary treatments. The coexistence of fcICA with FMD increases the risk of dissection, necessitating careful monitoring. The distinction between fenestration and pseudofenestration remains challenging, requiring comprehensive imaging and close collaboration between radiologists and vascular neurologists.
强调正确识别极为罕见的血管异常——颈椎内颈动脉窗（fcICA）的临床和诊断重要性，并报告一例最初误诊为纤维肌发育不良（FMD）患者颈动脉夹层的 fcICA 病例。
一名 47 岁女性因搏动性耳鸣接受计算机断层血管造影（CTA）和数字减影血管造影（DSA）检查，以区分颈内动脉窗和夹层。
CTA 显示右侧颈内动脉（ICA）C1 段远端呈梭形扩张，伴有线性充盈缺损，提示窗或夹层。DSA 证实右侧 ICA 段存在由两个对称、光滑壁组成的窗样分支，无夹层瓣，近端血管存在 FMD 迹象。患者的症状归因于 fcICA 和 FMD 引起的局部血流紊乱。
该病例表明，fcICA 可能是真正的解剖变异，而不是夹层的结果，强调需要准确的影像学诊断，以避免不必要的治疗。fcICA 与 FMD 共存增加了夹层的风险，需要密切监测。区分窗和假性窗仍然具有挑战性，需要放射科医生和血管神经科医生之间的全面影像学和密切协作。
