“Kissing” Retroesophageal Common Carotid Arteries with Left Common Carotid Artery Occlusion: A Rare Anatomical Variant

Anatomic variants of the aortic arch and carotid arteries are well recognized, and retropharyngeal or aberrant carotid courses have been described [1,2].However, a bilateral retroesophageal course of the common carotid arteries (CCAs) with symptomatic total occlusion of the left CCA has not been reported.Normally, the CCAs and internal carotid arteries ascend within the carotid sheath in the parapharyngeal space.While mild curvature variations occur in 20%-60% of the population [3], marked positional deviations are rare.In exceptional cases, both CCAs course medially behind the pharynx-termed "kissing carotids" [3]-passing anterior to the vertebral column and posterior to the airway.This configuration is usually incidental, but may have clinical implications, including altered hemodynamics, increased risk of vascular injury during airway manipulation or pharyngeal