{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:17:06Z","timestamp":1785403026057,"version":"3.56.0"},"reference-count":58,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tomography"],"abstract":"<jats:p>The carotid and vertebral arteries are critical components of the cerebral circulation, supplying the brain and spinal cord. Their embryologic development involves complex transformations of the aortic arches, paired dorsal aortae, and cervical intersegmental arteries. Congenital anomalies and variations involving their origin, course, and branching patterns are relatively common and are increasingly recognized using modern imaging. While many of these variants are incidental, some carry important clinical implications, particularly in contexts of stroke imaging, head and neck surgery, and neurointerventional procedures. This article reviews the embryologic development of the carotid and vertebral arterial systems, highlights normal and variant anatomy, and presents a case-based, illustrated overview of these congenital anomalies. Emphasis is placed on key findings utilizing computed tomography angiography (CTA), magnetic resonance angiography (MRA), and catheter angiography. Particular attention is given to structural and pathway variations, including vessel agenesis or hypoplasia, the aberrant internal carotid artery within the temporal bone, abnormal branching patterns, fenestrations, and persistent fetal anastomoses (such as the primitive trigeminal, hypoglossal, and proatlantal intersegmental arteries). Ultimately, familiarity with these anomalies, their embryological origins, and their distinct imaging characteristics is essential for ensuring accurate interpretation and avoiding diagnostic pitfalls and procedural complications.<\/jats:p>","DOI":"10.3390\/tomography12080111","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T08:09:42Z","timestamp":1785398982000},"page":"111","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Congenital Anomalies and Variations of the Carotid and Vertebral Arteries: A Case-Based Imaging Review"],"prefix":"10.3390","volume":"12","author":[{"given":"Bilal","family":"Battal","sequence":"first","affiliation":[{"name":"Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Zamora","sequence":"additional","affiliation":[{"name":"Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"620162","DOI":"10.1155\/2013\/620162","article-title":"Normal Anatomical Features and Variations of the Vertebrobasilar Circulation and Its Branches: An Analysis with 64-Detector Row CT and 3T MR Angiographies","volume":"2013","author":"Akgun","year":"2013","journal-title":"Sci. World J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"31","DOI":"10.4103\/0028-3886.30424","article-title":"Microsurgical Anatomy of the Posterior Circulation","volume":"55","author":"Pai","year":"2007","journal-title":"Neurol. India"},{"key":"ref_3","unstructured":"(2026, May 23). Anatomy Atlases: Illustrated Encyclopedia of Human Anatomic Variation: Opus II: Cardiovascular System: Arteries: Head, Neck, and Thorax: Anterior Inferior Cerebellar and Posterior Inferior Cerebellar Arteries. Available online: https:\/\/www.anatomyatlases.org\/AnatomicVariants\/Cardiovascular\/Text\/Arteries\/CerebellarAntPostInferior.shtml."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1007\/s00381-017-3629-1","article-title":"Congenital Absence of the Bilateral Internal Carotid Artery: A Review of the Associated (ab)normalities from a Newborn Status to the Eighth Decade of Life","volume":"34","year":"2018","journal-title":"Child\u2019s Nerv. Syst."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1007\/BF01773165","article-title":"Segmental Agenesis of the Internal Carotid Artery: Angiographic Aspects with Embryological Discussion","volume":"6","author":"Lasjaunias","year":"1984","journal-title":"Anat. Clin."},{"key":"ref_6","first-page":"e38063","article-title":"Retrospective Study of Normal Variations in Vertebral Artery on Computed Tomography Angiography With Special Emphasis on Relevant Embryology","volume":"15","author":"Phukan","year":"2023","journal-title":"Cureus"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1427","DOI":"10.2214\/ajr.172.5.10227532","article-title":"The Persistent Fetal Carotid-Vertebrobasilar Anastomoses","volume":"172","author":"Luh","year":"1999","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Chen, J., Liu, L., Kou, X., and Wang, C. (2023). Case Report: Right Vertebral and Carotid Artery Anomalies with an Aberrant Right Subclavian Artery in Two Patients. Front. Neurol., 14.","DOI":"10.3389\/fneur.2023.1282127"},{"key":"ref_9","unstructured":"Khalid, N., and Bordoni, B. (2026). Embryology, Great Vessel. StatPearls, StatPearls Publishing."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1363","DOI":"10.1007\/s00276-020-02549-w","article-title":"Rare Congenital Anomalies of the Internal Carotid Artery: Anatomic and Radiologic Aspects of Three Cases and Review of the Literature","volume":"42","year":"2020","journal-title":"Surg. Radiol. Anat. SRA"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1007\/s12055-020-01100-1","article-title":"Aberrant Origin of Right Vertebral Artery from the Arch of Aorta","volume":"37","author":"Das","year":"2021","journal-title":"Indian J. Thorac. Cardiovasc. Surg."},{"key":"ref_12","first-page":"21","article-title":"Anomalous Right Vertebral Artery Originating from the Aortic Arch Distal to the Left Subclavian Artery: A Case Report and Review of the Literature","volume":"8","author":"Case","year":"2015","journal-title":"J. Vasc. Interv. Neurol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"George, B., Bruneau, M., and Spetzler, R.F. (2011). Embryology of the Vertebral Artery. Pathology and Surgery Around the Vertebral Artery, Springer.","DOI":"10.1007\/978-2-287-89787-0"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"231","DOI":"10.7461\/jcen.2018.20.4.231","article-title":"A Type 1 Persistent Proatlantal Artery Originating from the External Carotid Artery Detected by Computed Tomographic Angiography","volume":"20","author":"Choi","year":"2018","journal-title":"J. Cerebrovasc. Endovasc. Neurosurg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"267","DOI":"10.2176\/nmc.ra.2017-0050","article-title":"Carotid-Vertebrobasilar Anastomoses with Reference to Their Segmental Property","volume":"57","author":"Namba","year":"2017","journal-title":"Neurol. Med. Chir."},{"key":"ref_16","first-page":"1414","article-title":"Abnormal Origin of the Vertebral Artery from the Common Carotid Artery","volume":"19","author":"Chen","year":"1998","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1007\/s10140-008-0756-8","article-title":"A Rare Combination of Carotid Artery Congenital Abnormalities: Understanding the Embryology and Clinical Associations","volume":"16","author":"McEachen","year":"2009","journal-title":"Emerg. Radiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"160","DOI":"10.3174\/ajnr.A6851","article-title":"The Many Faces of Persistent Stapedial Artery: CT Findings and Embryologic Explanations","volume":"42","author":"LoVerde","year":"2021","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_19","unstructured":"Osborn, A.G., Hedlund, G.L., and Salzman, K.L. (2017). Osborn\u2019s Brain: Imaging, Pathology, and Anatomy, Elsevier. [2nd ed.]."},{"key":"ref_20","first-page":"1953","article-title":"Congenital Absence of the Internal Carotid Artery: Case Reports and Review of the Collateral Circulation","volume":"22","author":"Given","year":"2001","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_21","first-page":"2635","article-title":"Agenesis of Bilateral Internal Carotid Arteries and Posterior Fossa Abnormality in a Patient with Facial Capillary Hemangioma: Presumed Incomplete Phenotypic Expression of PHACE Syndrome","volume":"26","author":"Weon","year":"2005","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_22","first-page":"89","article-title":"Bilateral Agenesis of the Internal Carotid Artery Associated with Basilar Artery Aneurysm Treated via the Endovascular Route. A Case Report","volume":"16","author":"Barbosa","year":"2010","journal-title":"Interv. Neuroradiol. J. Peritherapeutic Neuroradiol. Surg. Proced. Relat. Neurosci."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"257","DOI":"10.4103\/0971-3026.90682","article-title":"Bilateral Hypoplasia of the Internal Carotid Artery","volume":"21","author":"Bhat","year":"2011","journal-title":"Indian J. Radiol. Imaging"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1177\/19714009221108668","article-title":"Congenital Internal Carotid Artery Hypoplasia: A Systematic Review","volume":"36","author":"Whitley","year":"2023","journal-title":"Neuroradiol. J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e315","DOI":"10.1097\/SCS.0000000000001701","article-title":"PHACE(S) Syndrome With Absent Intracranial Internal Carotid Artery and Anomalous Circle of Willis","volume":"26","author":"Winter","year":"2015","journal-title":"J. Craniofac. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"bcr2016216177","DOI":"10.1136\/bcr-2016-216177","article-title":"Congenital Absence of Bilateral ICA: An Unusual Incidental Finding in an Adult Male","volume":"2016","author":"Furruqh","year":"2016","journal-title":"BMJ Case Rep."},{"key":"ref_27","first-page":"762","article-title":"Bilateral Aberrant Internal Carotid Arteries with Bilateral Persistent Stapedial Arteries and Bilateral Duplicated Internal Carotid Arteries","volume":"24","author":"Roll","year":"2003","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1007\/s00234-012-1034-8","article-title":"Lateralized Petrous Internal Carotid Artery: Imaging Features and Distinction from the Aberrant Internal Carotid Artery","volume":"54","author":"Glastonbury","year":"2012","journal-title":"Neuroradiology"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"169","DOI":"10.3348\/jksr.2014.71.4.169","article-title":"Aberrant Internal Carotid Artery in the Middle Ear","volume":"71","author":"Roh","year":"2014","journal-title":"J. Korean Soc. Radiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1288\/00005537-199403000-00012","article-title":"Prevalence of Facial Canal Dehiscence and of Persistent Stapedial Artery in the Human Middle Ear: A Report of 1000 Temporal Bones","volume":"104","author":"Moreano","year":"1994","journal-title":"Laryngoscope"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1177\/000348949310200914","article-title":"Persistent Stapedial Artery: Does It Prevent Successful Surgery?","volume":"102","author":"Govaerts","year":"1993","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1136\/jnnp.36.5.874","article-title":"An Anomalous Origin of the Middle Meningeal Artery","volume":"36","author":"Royle","year":"1973","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.aorl.2009.08.001","article-title":"Persistent stapedial artery with otosclerosis","volume":"126","author":"Breheret","year":"2009","journal-title":"Ann. d\u2019Otolaryngol. Chir. Cervico-Faciale"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1097\/MAO.0000000000001466","article-title":"Surgical Management of a Persistent Stapedial Artery: A Review","volume":"38","author":"Goderie","year":"2017","journal-title":"Otol. Neurotol. Off. Publ. Am. Otol. Soc. Am. Neurotol. Soc. Eur. Acad. Otol. Neurotol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1007\/s00276-013-1127-z","article-title":"Persistent Stapedial Arteries in Human: From Phylogeny to Surgical Consequences","volume":"35","author":"Hitier","year":"2013","journal-title":"Surg. Radiol. Anat. SRA"},{"key":"ref_36","first-page":"e71120","article-title":"Anatomical Variations of the Bifurcation Levels of the Common Carotid Artery and Superior Thyroid Artery","volume":"16","author":"Abdalla","year":"2024","journal-title":"Cureus"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Sheikh-Bahaei, N., Matys, T., and Gillard, J.H. (2014). Anatomy of the Neck Arteries. Neurovascular Imaging, Springer.","DOI":"10.1007\/978-1-4614-9212-2_2-1"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1007\/s00276-025-03658-0","article-title":"Absent Right Common Carotid Artery Associated with Left Accessory Middle Cerebral Artery Diagnosed by Computed Tomography Angiography","volume":"47","author":"Hashio","year":"2025","journal-title":"Surg. Radiol. Anat. SRA"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"124","DOI":"10.3348\/jksr.2015.73.2.124","article-title":"Separate Origins of the Internal and External Carotid Arteries Depicted on CT Angiography: A Case Report","volume":"73","author":"Choi","year":"2015","journal-title":"J. Korean Soc. Radiol."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Tudose, R.C., Rusu, M.C., and Hostiuc, S. (2023). The Vertebral Artery: A Systematic Review and a Meta-Analysis of the Current Literature. Diagnostics, 13.","DOI":"10.3390\/diagnostics13122036"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1177\/2396987317700540","article-title":"Increased Risk for Posterior Circulation Ischaemia in Patients with Vertebral Artery Hypoplasia: A Systematic Review and Meta-Analysis","volume":"2","author":"Katsanos","year":"2017","journal-title":"Eur. Stroke J."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"8","DOI":"10.2176\/nmc.41.8","article-title":"High Incidence of Arterial Dissection Associated with Left Vertebral Artery of Aortic Origin","volume":"41","author":"Komiyama","year":"2001","journal-title":"Neurol. Med. Chir."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1007\/s00062-012-0171-0","article-title":"Origin and Course of the Extracranial Vertebral Artery: CTA Findings and Embryologic Considerations","volume":"22","author":"Meila","year":"2012","journal-title":"Clin. Neuroradiol."},{"key":"ref_44","first-page":"e61623","article-title":"Variations in the Origin and Course of the Extracranial Vertebral Artery on Multidetector Computed Tomography Angiography","volume":"15","author":"Lin","year":"2016","journal-title":"Iran. J. Radiol."},{"key":"ref_45","first-page":"e245","article-title":"Vertebral Artery Fenestration","volume":"7","author":"Ozpinar","year":"2015","journal-title":"Cureus"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1007\/BF00327480","article-title":"Fenestration and Duplicate Origin of the Left Vertebral Artery in Angiography. Report of Three Cases","volume":"25","author":"Rieger","year":"1983","journal-title":"Neuroradiology"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"2154","DOI":"10.3889\/oamjms.2019.563","article-title":"Fenestrated Vertebral Artery in A Routine Cadaveric Dissection","volume":"7","author":"Fakoya","year":"2019","journal-title":"Open Access Maced. J. Med. Sci."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1111\/j.1440-1673.1991.tb03012.x","article-title":"Duplication of the Vertebro-Basilar System","volume":"35","author":"Soo","year":"1991","journal-title":"Australas. Radiol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1007\/s12565-019-00482-6","article-title":"Incidence of Vertebral Artery of Aortic Arch Origin, Its Level of Entry into Transverse Foramen, Length, Diameter and Clinical Significance","volume":"94","author":"Woraputtaporn","year":"2019","journal-title":"Anat. Sci. Int."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1002\/ca.980080107","article-title":"Primitive Persistent Carotid-Basilar and Carotid-Vertebral Anastomoses: A Report of Seven Cases and a Review of the Literature","volume":"8","author":"Yilmaz","year":"1995","journal-title":"Clin. Anat."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"329","DOI":"10.3109\/00016925909171103","article-title":"Patent Primitive Trigeminal Artery Studied by Cerebral Angiography","volume":"51","author":"Saltzman","year":"1959","journal-title":"Acta Radiol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1097\/00006123-199809000-00082","article-title":"Persistent Trigeminal Artery: An Anatomic Study","volume":"43","author":"Salas","year":"1998","journal-title":"Neurosurgery"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1258\/ar.2011.110191","article-title":"Classification of Persistent Primitive Trigeminal Artery (PPTA): A Reconsideration Based on MRA","volume":"52","author":"Weon","year":"2011","journal-title":"Acta Radiol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1016\/j.crad.2010.06.010","article-title":"Impact of Anatomical Variations of the Circle of Willis on the Incidence of Aneurysms and Their Recurrence Rate Following Endovascular Treatment","volume":"65","author":"Songsaeng","year":"2010","journal-title":"Clin. Radiol."},{"key":"ref_55","first-page":"175","article-title":"A Case of Aneurysm on a Persistent Hypoglossal Artery Treated by Endovascular Coiling","volume":"15","author":"Medicamento","year":"2009","journal-title":"Interv. Neuroradiol. J. Peritherapeutic Neuroradiol. Surg. Proced. Relat. Neurosci."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1007\/BF03187405","article-title":"Persistent Hypoglossal Artery Encountered during Carotid Endarterectomy","volume":"3","author":"McCartney","year":"1989","journal-title":"Ann. Vasc. Surg."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1007\/s00701-025-06654-w","article-title":"Persistent Primitive Hypoglossal Artery: A Classification-Based Approach to Understanding and Managing a Rare Vascular Anomaly","volume":"167","author":"Elsayed","year":"2025","journal-title":"Acta Neurochir."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"198","DOI":"10.25259\/SNI_1093_2024","article-title":"A Type II Proatlantal Artery Arising from the External Carotid Artery: A Review of Neurovascular Anatomy","volume":"16","author":"Baskaran","year":"2025","journal-title":"Surg. Neurol. Int."}],"container-title":["Tomography"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2379-139X\/12\/8\/111\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T08:56:21Z","timestamp":1785401781000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2379-139X\/12\/8\/111"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,30]]},"references-count":58,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["tomography12080111"],"URL":"https:\/\/doi.org\/10.3390\/tomography12080111","relation":{},"ISSN":["2379-139X"],"issn-type":[{"value":"2379-139X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,30]]}}}