Dangerous anatomic variation of internal carotid artery – a rare case report

The internal carotid artery (ICA) has a straight cervical course up to the cranial base, and does not emit branches in this course. In 10 to 40% of the cases there are anatomic variations in this course, and the most common are curvatures, elbowing and notches [1]. Anatomical variants of the ICA have been reported with a large variability of pattern and degree. Among these variants, an unusual retropharyngeal course of ICA can mimic parapharyngeal neoplasm and pose a risk of vascular injury during pharyngeal intervention. Devastating complications can result from biopsy, surgical and anesthetic procedures. Medial deviation of the ICA is a rare cause of widening of the retropharyngeal space. In children, the diagnosis of these variations must always be predicted, especially in patients prone to adenotonsillectomy, in which incidental lesions during the surgical process may have catastrophic consequences [2, 3]. In elder people, such variations may often be associated with arteriosclerosis and thrombosis that may affect the blood flow and cause encephalic ischemic processes [1].