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The congenital absence of the common carotid artery is a rare anatomic variation. It was originally described in cadaver specimens and has subsequently been identified, incidentally, with multiple imaging modalities. Symptomatic disease of the internal carotid artery arising from the innominate artery has only been described once. An endovascular approach to treatment has yet to be reported.
We present the case of a 74 year-old female who presented with a right-hemispheric cerebral vascular accident (CVA). An 80% stenosis was noted in the right internal carotid artery (ICA) on computerized tomographic angiography. The ICA originated on the innominate artery with a congenitally absent right common carotid artery. Duplex ultrasonography and digital subtraction angiography confirmed the anatomic findings. Given the location of the stenosis below the clavicle, and the patient’s underlying comorbidities, the patient was treated with a carotid stent using embolic protection without complication. This rare anatomical variant can be treated successfully with percutaneous techniques, avoiding the morbidity of thoracotomy and general anesthesia.