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Variant ascending pharyngeal artery maintaining flow in a subocclusive internal carotid artery
  1. Brian D Kim1,
  2. Thomas J Oxley2,
  3. Johanna T Fifi2 and
  4. Hazem Shoirah3
  1. 1 Neurology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
  2. 2 Neurosurgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
  3. 3 Neurosurgery, Neurology, Radiology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
  1. Correspondence to Dr Brian D Kim,{at}


Ectopic branches of the external carotid artery are rare but have critical diagnostic and therapeutic implications. We present a case involving a 70-year-old man who presented with recurrent left hemispheric strokes in the setting of a subocclusive left internal carotid stenosis. A left ascending pharyngeal artery with variant origin from the internal carotid artery helped maintain flow distal to the area of stenosis and allowed for safe and successful internal carotid artery stenting. Identification of this variant and recognition of the anastomotic network involving this connection were crucial to determine the safety of stenting. The patient had no further recurrent events and had sustained improvement on his 90-day follow-up.

  • stroke
  • neuroimaging
  • neurosurgery
  • interventional radiology

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  • Contributors BDK contributed to the design, writing, revision and submission of this manuscript. TJO and JTF contributed to data acquisition, analysis and interpretation, and revision of the manuscript. HS contributed to all of the above stated, including data acquisition, interpretation, and manuscript writing and revision. All authors have approved the final submission of this manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Next of kin consent obtained.