Here we report, for the first time, a combination of five-vessel aortic arch, anomalous origin of the right vertebral artery (VA) from the common carotid artery (CCA), an aberrant right subclavian artery (SCA), and bilateral symmetrical segmental agenesis of VAs.In this case report, we present a patient with moyamoya syndrome (MMS) and Down syndrome (DS) who has bilateral symmetrical segmental agenesis of VAs, left VA originating from aortic arch and anomalous origin of right VA arising from CCA in combination with an aberrant right SCA. Therefore, five vessels are originating from aortic arch. Here, we report, for the first time, a combination of five-vessel aortic arch with an aberrant right SCA and symmetrical segmental agenesis of both VAs. The possible embryological mechanisms of the anomalies as well as an relation with MMS and DS are discussed.
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Republished with permission from BMJ Case Reports Published 23 January 2018; doi: 10.1136/bcr-2017-013464.
Contributors PB: identified the case, performed literature review, interpreted and analysed angiographic images and wrote the manuscript. GB had substantial contributions to the design of the work, critically revised the draft paper, final approval of the paper to be published and was scientific advisor. NK had contributions to the design of the work, revised the paper, maintained patient’s consent and ethics approval.
Competing interests None declared.
Patient consent Obtained.
Ethics approval Informed consent for publication was obtained in accordance to our ethics committee review board approval (BASEC no. 2016-00880).
Provenance and peer review Not commissioned; externally peer reviewed.