Anomalous Origin of Bilateral Vertebral Arteries from the ICA: Review of the Literature and a Case Report

Atypical origins of the vertebral arteries (VAs) are rare anatomic findings. In this study, we present an extremely rare arrangement of the cerebral circulation in a 72-year-old male patient. The anatomic rarity, which was detected using ultrasonic imaging, involved the bilateral VAs coming off the internal carotid arteries (ICAs). Because the ICA and VA on the left side were severely stenotic, the vascular surgeons performed carotid and vertebral endarterectomy simultaneously. Although stenosis can be eliminated from these arteries, this type of rare anatomy results in more difficulties and risks for the patient. Ultrasound imaging provides high anatomic detail during this unique operation.