Intrathoracic Bifurcation of the Left Common Carotid Artery with a Symptomatic Internal Carotid Artery Stenosis

Abstract

A forty-eight-year-old woman was evaluated for left hemispheric and transient left monocular symptoms referable to the carotid bifurcation. She was found to have an intrathoracic bifurcation of the left common carotid artery. The angiogram showed a 95% stenosis of the proximal left internal carotid artery arising at an intrathoracic location off a short trunk of the left common carotid artery. She had a history of a Blalock-Taussig shunt and a later total correction of Fallot's tetralogy. Operative correction of the carotid lesion consisted of cervical transposition of the left internal carotid artery to the left external carotid artery. Her postoperative course was uneventful, and follow-up for nearly a year continues to demonstrate a widely patent reconstruction with resolution of her symptoms.

The carotid bifurcation may be found at varying locations in the neck; however, a review of the English literature did not disclose any reports of an intrathoracic carotid bifurcation. Given the potential for misdiagnosis, this abnormality should be considered when the bifurcation is not found in its more usual locale on duplex interrogation of this artery.