INTRATHORACIC BIFURCATION OF THE LEFT COMMON CAROTID-ARTERY WITH A SYMPTOMATIC INTERNAL CAROTID-ARTERY STENOSIS - CASE-REPORT

A forty-eight-year-old woman was evaluated for left hemispheric and tr ansient 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 le ft 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 tetralo gy. Operative correction of the carotid lesion consisted of cervical t ransposition 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 reconstruc tion with resolution of her symptoms. The carotid bifurcation may be f ound at varying locations in the neck; however, a review of the Englis h literature did not disclose any reports of an intrathoracic carotid bifurcation. Given the potential for misdiagnosis, this abnormality sh ould be considered when the bifurcation is not found in its more usual locale on duplex interrogation of this artery.