Imaging and Clinical Findings in Patients with Aberrant Course of the Cervical Internal Carotid Arteries

Alberto Muñoz1, *, Joaquín De Vergas2, José Crespo3
1 Dpto. de Radiología, Facultad de Medicina, Ciudad Universitaria, Pabellón II, Planta 1ª, 28040, Madrid, Spain
2 Servicio de ORL, Hospital Universitario “12 de Octubre”, C/ Glorieta de Málaga, 28041, Madrid, Spain
3 GIB – LIA, DLSIIS, Facultad de Informática, Universidad Politécnica de Madrid, 28660 Boadilla del Monte (Madrid), Spain

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© Muñoz et al; Licensee Bentham Open

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Dpto. de Radiología, Facultad de Medicina, Ciudad Universitaria, Pabellón II, Planta 1ª, 28040, Madrid, Spain; Tel: 91-3941514; Fax: (34) 91 3941514; E-mail:


Background and Purpose:

Aberrrant course of the cervical internal carotid arteries (ICAs) may result in submucosal masses in the posterior pharyngeal wall, may cause confusion at physical examination, may be symptomatic, and can be at risk of surgical injury. The aim of this report is to present the clinical and imaging characteristics associated with aberrant course of the cervical portion of the ICAs.


Imaging studies of 5.500 patients were prospectively selected from CT studies of the head and neck performed in a five years period, in which the course of the one or both ICAs at the level of the hypopharynx and oropharynx was assessed as aberrant by means of a proposed classification. We then reviewed the medical records to establish which symptoms were present and if these symptoms could be caused by these variations in the course of the ICAs. In selected cases, further studies including magnetic resonance (MR) imaging, MR angiography (MRA), or selective catheter angiography were obtained.


In our restricted classification, we found 14 (0.2%) patients who met the cervical ICA aberrancy criteria. In all patients contrast enhanced CT or CT angiography was performed, 4 also have had MRI and MRA, and in two additional catheter angiograms were performed. Mean age was 62 years. Eight patients were male and seven were female. Four patients (28%) were considered to have clinical symptoms related to aberrant course of the ICAs. In most of the symptomatic patients both ICAs had aberrant courses. Overall, the course of the right ICA was aberrant in 43%, the left ICA in 14%, and both in 43%. In 50% of the cases the aberrancy of the artery was focal (localized to the oropharynx or laryngopharynx) and in the other 50% it involved the entire cervical course of the ICA.


In most of our patients variations in the course of the cervical portion of the ICA involved the right side and were asymptomatic, except with regard to potential surgical risks. However, in about 25% of our patients these variations were thought to be the culprit of patient complaints, particularly oropharyngeal pulsatile sensation. Furthermore, extreme degrees of medialization of the ICAs resulted in progressive symptoms including hoarseness and upper respiratory distress.

Keywords: Internal carotid artery, anomalies, internal carotid artery, aberrancy, head and neck, carotid artery.