{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T09:52:03Z","timestamp":1776678723001,"version":"3.51.2"},"reference-count":12,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T00:00:00Z","timestamp":1775088000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Fondazione Emilio Trabucchi"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction: The retropharyngeal carotid artery (RCA) is a rare anatomical variant where the carotid artery resides in the retropharyngeal space. The co-occurrence of RCA and significant atherosclerotic stenosis of the carotid bifurcation is even rarer. Recognizing this anatomy is crucial because of the increased risk of adverse events during procedures such as intubation or oropharyngeal surgery. Furthermore, differentiating between the fixed and dynamic forms is essential for guiding appropriate diagnostic and therapeutic strategies. A scoping review was undertaken, and two cases of RCA and significant internal carotid artery stenosis requiring a surgical approach were presented. Materials and Methods: EMBASE and OVID were systematically searched for studies reporting data on RCA and significant internal carotid artery stenosis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) was followed, and we presented two case reports of RCA and significant internal carotid artery stenosis requiring surgical treatment, treated at the Division of Vascular Surgery, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy. Results and Discussion: Among the 22 papers identified by the scoping review, 6 case reports were ultimately included in the analysis, supplemented by our two cases. The review and the added cases highlight significant heterogeneity in the clinical presentation and management of RCA with stenosis. Therapeutic options include carotid endarterectomy (CEA), transfemoral carotid artery stenting (TF-CAS), and transcarotid artery revascularization (TCAR). Also, the diagnostic with dynamic 3D-CT angiography during swallowing would be important in some symptomatic cases to document mechanical compression by the hyoid bone or thyroid cartilage (dynamic RCA), which standard static imaging failed to detect. Conclusions: Due to the rarity of the condition, no high-level evidence (RCTs) exists. Treatment decisions are based on the qualitative assessment of anatomical risk and isolated case reports. Standard interventions (CEA and TF-CAS) are generally considered high-risk. The final management choice must be individualized based on technical feasibility, neurological risk, and the determination of whether the pathology is fixed or dynamically compressive.<\/jats:p>","DOI":"10.3390\/jcm15072683","type":"journal-article","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T07:57:55Z","timestamp":1775116675000},"page":"2683","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Retropharyngeal Internal Carotid Artery Stenosis: A Case-Based Narrative Review"],"prefix":"10.3390","volume":"15","author":[{"given":"Chiara","family":"Caruso","sequence":"first","affiliation":[{"name":"Division of Vascular Surgery, IRCCS MultiMedica, Sesto San Giovanni, 20099 Milan, Italy"},{"name":"School of Vascular Surgery, Universit\u00e0 degli Studi di Milano, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Verlato","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery, IRCCS MultiMedica, Sesto San Giovanni, 20099 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Omar","family":"Odeh","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery, IRCCS MultiMedica, Sesto San Giovanni, 20099 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberta","family":"Munao","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery, IRCCS MultiMedica, Sesto San Giovanni, 20099 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"Rossi","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery, IRCCS MultiMedica, Sesto San Giovanni, 20099 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Besjona","family":"Puta","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery, IRCCS MultiMedica, Sesto San Giovanni, 20099 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Massimiliano","family":"Martelli","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery, IRCCS MultiMedica, Sesto San Giovanni, 20099 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7802-1969","authenticated-orcid":false,"given":"Alberto Maria","family":"Settembrini","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery, IRCCS MultiMedica, Sesto San Giovanni, 20099 Milan, Italy"},{"name":"UniCamillus-Saint Camillus International, Department of Vascular Surgery, University of Health Sciences, 00118 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"E109","DOI":"10.1097\/BRS.0b013e31827b0d4b","article-title":"Incidence and Risk Factors of the Retropharyngeal Carotid Artery on Cervical Magnetic Resonance Imaging","volume":"38","author":"Koreckij","year":"2013","journal-title":"Spine"},{"key":"ref_2","first-page":"e78788","article-title":"Wandering Carotid Artery in Carotid Artery Stenting","volume":"17","author":"Ogata","year":"2025","journal-title":"Cureus"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"268.e1","DOI":"10.1016\/j.avsg.2016.01.019","article-title":"Stenting of a Retropharyngeal Internal Carotid Artery","volume":"34","author":"Martin","year":"2016","journal-title":"Ann. Vasc. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"29S","DOI":"10.1016\/j.jvs.2024.01.085","article-title":"CEA and CAS for Retropharyngeal Internal Carotid Stenosis: Two Different Ways to Treat the Same Disease","volume":"79","author":"Martelli","year":"2024","journal-title":"J. Vasc. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1189.e1","DOI":"10.1016\/j.avsg.2013.02.023","article-title":"Retropharyngeal internal carotid artery: Arare presentation with significant clinical implications","volume":"27","author":"Mousa","year":"2013","journal-title":"Ann. Vasc. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1002\/lary.23393","article-title":"Variability in the position of the retropharyngeal internal carotid artery","volume":"123","author":"Gupta","year":"2013","journal-title":"Laryngoscope"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"101630","DOI":"10.1016\/j.jvscit.2024.101630","article-title":"Retropharyngeal carotid artery stenosis: Potential for minimizing operative complications utilizing transcarotid artery stent revascularization","volume":"10","author":"Shennib","year":"2024","journal-title":"J. Vasc. Surg. Cases Innov. Tech."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1468","DOI":"10.1016\/j.radcr.2020.06.016","article-title":"Dynamic 3D-CT angiography during swallowing for diagnosing hyoid bone or thyroid cartilage compression-induced thromboembolism","volume":"15","author":"Yamaguchi","year":"2020","journal-title":"Radiol. Case Rep."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"CASE2483","DOI":"10.3171\/CASE2483","article-title":"Mechanical compression of the carotid artery by the pharynx in the retropharyngeal space during swallowing and the induction of stenosis and embolic stroke: Illustrative case","volume":"8","author":"Suematsu","year":"2024","journal-title":"J. Neurosurg. Case Lessons"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"750.e11","DOI":"10.1016\/j.wneu.2016.10.097","article-title":"Mild Carotid Stenosis with Recurrent Symptoms Triggered by Eating","volume":"97","author":"Gates","year":"2017","journal-title":"World Neurosurg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"884","DOI":"10.1177\/15385744241276644","article-title":"Transcarotid Artery Revascularization for Symptomatic Retropharyngeal Internal Carotid Artery Stenosis","volume":"58","author":"Ettleson","year":"2024","journal-title":"Vasc. Endovasc. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"467","DOI":"10.7326\/M18-0850","article-title":"PRISMA Extension for Scoping Reviews (PRISMAScR): Checklist and Explanation","volume":"169","author":"Tricco","year":"2018","journal-title":"Ann. Intern. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/7\/2683\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T08:57:29Z","timestamp":1776675449000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/7\/2683"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,2]]},"references-count":12,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["jcm15072683"],"URL":"https:\/\/doi.org\/10.3390\/jcm15072683","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,2]]}}}