Persistent Type 1 Proatlantal Artery Associated with Internal Carotid Artery Stenosis Treated by Percutaneous Angioplasty

Artéria Proatlantal Tipo 1 Persistente Associada à Estenose da Artéria Carótida Interna Tratada por Angioplastia Percutânea

• João Pedro Einsfeld Britz
• Maria Paula Dumoncel
• Ricardo Bettin Foster
• Márcio Severo Garcia
• Gabriel Mossmann

• https://doi.org/10.22290/jbnc.2025.360311
• J Bras Neurocirur 36 (3):410-416, 2025

Resumo

A artéria proatlantal (AP) é uma variação anatômica rara resultante da persistência deste vaso desde o período embriológico e conecta a artéria carótida interna (ACI) com o sistema vertebrobasilar. Paciente masculino de 67 anos com sintomas isquêmicos cerebrais foi investigado com arteriografia, que demonstrou AP como fonte de suprimento sanguíneo para estruturas da fossa posterior. Foi identificada uma estenose de 70% da ACI associada à AP e tratada com angioplastia com stent. A AP é uma anomalia anatômica rara e, quando associada à ateromatose carotídea, pode causar eventos isquêmicos na circulação anterior e posterior. O tratamento pode ser desafiador devido à complexa anatomia relacionada a essa alteração anatômica.

Palavras-chave

Doenças das artérias carótidas; Estenose carótida; Doenças cerebrovasculares; Acidente vascular cerebral

Abstract

The proatlantal artery (PA) is a rare anatomical variation resulting from the persistence of this vessel from the embryological period and connects the internal carotid artery (ICA) with the vertebrobasilar system. A 67-year-old male presented with cerebral ischemic symptoms was investigated with arteriography, which demonstrated a PA as the source of blood supply to structures of the posterior fossa. A 70% stenosis of the ICA was identified associated with the PA and treated with stent angioplasty. PA is a rare anatomical anomaly and, when associated with carotid atheromatosis, can cause ischemic events in the anterior and posterior circulation. Treatment can be challenging due to the complex anatomy related to this anatomical alteration.

Keywords

Carotid artery diseases; Carotid stenosis; Cerebrovascular disorders; Stroke

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1Neurosurgery Department, Hospital Cristo Redentor, Porto Alegre, RS, Brazil.

2School of Medicine, Universidade Luterana do Brasil – ULBRA, Canoas, RS, Brazil.

3Department of Interventional Neuroradiology, Hospital Nossa Senhora da Conceição, Porto Alegre, RS, Brazil.

 

Received Apr 16, 2025

Accepted Apr 25, 2025