Abstract WP334: Wandering Carotid Artery, a Rare Etiology for Cryptogenic Stroke

Background: A substantial proportion of stroke in young individuals is cryptogenic. One possible etiology which has rarely been reported is a wandering carotid artery. We report a case of this phenomenon and review the literature to address diagnostic and stroke management in this clinical conundrum. Methods: A case history and imaging were reviewed. A literature search was conducted with emphasis on keywords including ‘wandering carotid artery’ and relationship to ‘cryptogenic stroke.’ Results: A 52 year old male presented with recurrent right MCA infarcts (2004, 2013, 2016, 2019) of cryptogenic etiology despite extensive prior cardioembolic/ischemic workup. Deficits included left hemiparesis, left hemisensory loss, left homonymous hemianopia, and post-stroke epilepsy. On closer review of serial head/neck imaging the right cervical internal carotid artery moved from a retropharyngeal position to lateral position between imaging studies (figure 1, figure 2). Dynamic carotid ultrasound was obtained and showed that the right greater cornu of the hyoid bone was located at the neutral position at the bifurcation of the right internal carotid artery, between the ECA and ICA, and caused deflection of the right ICA with decreased flow velocities. While the hyoid bone appeared normal in size and location, this raised the possibility of a wandering carotid artery. Given the extensive workup without clear cause, he underwent surgical fixation of the right carotid artery to the surrounding fascia, partial resection of the right hyoid bone, thyrohoid ligament, and superior cornu of the right thyroid cartilage. Following surgical correction, the patient did not have further ischemic events. There is limited literature on wandering carotid artery and its relationship to cyptogenic stroke. Several cases have previously noted stroke due to compression of the ICA by the hyoid bone, however, compression of a wandering ICA directly causing stroke is less reported. From reviewing the literature only one other such case has been reported although that patient presented with first occurrence of stroke rather than serial recurrent anterior circulation infarcts over years as in the case presented here. Conclusion: In conclusion, wandering carotid artery is a cause of cryptogenic anterior circulation large artery strokes that is often not considered and whose frequency is unknown. Further investigation of this entity can be studied with dynamic carotid ultrasound and serial CTA/MRA.