case_images: PMC11378703_01
case_images: (A) Normal waveforms and velocity in the right common carotid artery (CCA); (B) small left CCA suggesting abnormal development; (C) proximal left internal carotid artery displaying "flame-like" appearance.
case_images: mdcvj-20-1-1417-g1.jpg
case_images: PMC11378703_01_mdcvj-20-1-1417-g1.jpg
case_images: F1
case_images: We observed a small left CCA (Figure 1A, B) and a large external carotid artery with multiple, prominent branches. Only the most proximal portion of the small-caliber left ICA was visualized, and it exhibited a flame-like appearance (Figure 1C).
case_images: Absent left internal carotid artery with good cross-filling via contralateral anterior cerebral artery.
case_images: mdcvj-20-1-1417-g2.jpg
case_images: PMC11378703_01_mdcvj-20-1-1417-g2.jpg
case_images: F2
case_images: MRA of the head without contrast suggested "occlusion" of the left ICA with good cross-filling of the left middle cerebral artery (MCA) territory by way of the anterior communicating artery; a large left posterior communicating artery was noted (Figure 2A, B).
case_images: Transcranial Doppler image of the left and right middle cerebral arteries (MCA). Unexpectedly normal left MCA waveform. ICA: internal carotid artery; TCD: transcranial Doppler
case_images: mdcvj-20-1-1417-g3.jpg
case_images: PMC11378703_01_mdcvj-20-1-1417-g3.jpg
case_images: F3
case_images: Of these outpatient tests, the only unusual finding was the TCD examination (Figure 3).
case_images: (A, B) Ultrasound and digital subtraction angiography demonstrating a tapered, "flame-like" left internal carotid artery. (C) Illustration of the anatomical configuration.
case_images: mdcvj-20-1-1417-g4.jpg
case_images: PMC11378703_01_mdcvj-20-1-1417-g4.jpg
case_images: F4
case_images: Late-phase DSA showed a small caliber cervical ICA, which occluded at the skull base (Figure 4A, C).
case_images: Computed tomography demonstrating absent carotid canal at the base of the skull on the left.
case_images: mdcvj-20-1-1417-g5.jpg
case_images: PMC11378703_01_mdcvj-20-1-1417-g5.jpg
case_images: F5
case_images: These findings could have been consistent with the previous diagnosis of left ICA dissection; however, the revealing finding was in the CT result, which demonstrated absence of the carotid canal (Figure 5).