Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist, Houston, Texas, US.
Methodist Debakey Cardiovasc J. 2024 Sep 2;20(1):87-93. doi: 10.14797/mdcvj.1417. eCollection 2024.
Agenesis or hypoplasia of the internal carotid artery (ICA) may easily be confused with dissection or occlusion. We report a case of a 24-year-old female with complaint of acute left-hand hypoesthesia and a history of occasional intermittent numbness of her right hand with myoclonic jerking. Because previous imaging studies over 2 years were interpreted as occlusion of the left ICA secondary to carotid dissection, the treating physician had prescribed anticoagulant therapy. During transcranial Doppler (TCD) examination, the spectral waveform was unexpectedly normal, prompting a repeat review of all imaging due to the TCD results. Magnetic resonance angiography (MRA) revealed the same "flame-like" appearance of the ICA origin. Late-phase digital subtraction angiography showed a small caliber cervical ICA (occluded at the skull base). Computed tomography demonstrated absence of the carotid canal, confirming an absent intracranial portion of the ICA and establishing a correct diagnosis of left internal carotid hypoplasia. Vascular ultrasound and TCD examinations are noninvasive and inexpensive tools that can improve the interpretation and understanding of the clinical significance of other "static" radiographic tests (MRA, digital subtraction angiography ). An accurate diagnosis is essential to avoid risky, aggressive treatment, such as anticoagulation for an "absent" dissection.
颈内动脉（ICA）发育不全或发育不良很容易与夹层或闭塞混淆。我们报告了一例 24 岁女性，诉左手急性感觉减退，并伴有右手间歇性麻木伴肌阵挛。由于 2 年来的影像学检查结果提示为颈动脉夹层引起的左侧颈内动脉闭塞，治疗医生曾开具抗凝治疗。经颅多普勒（TCD）检查，频谱波形意外正常，鉴于 TCD 结果，再次全面复查所有影像学。磁共振血管造影（MRA）显示 ICA 起源处呈相同的“火焰样”外观。晚期数字减影血管造影显示颈内动脉小口径（基底颅底闭塞）。计算机断层扫描显示颈动脉管缺失，证实颈内动脉颅内段缺失，明确左侧颈内动脉发育不良的诊断。血管超声和 TCD 检查是无创且经济的工具，可以提高对其他“静态”影像学检查（MRA、数字减影血管造影）的临床意义的解释和理解。准确的诊断对于避免危险的、激进的治疗至关重要，例如对“不存在”的夹层进行抗凝治疗。
