A Case of Congenital Internal Carotid Artery Hypoplasia and its Influence on Related Anatomy

Congenital hypoplasia of the internal carotid artery (ICA) is a rare vascular anomaly often identified incidentally.This case highlights both local and distant morphological consequences of this anomalous finding and uses reconstruction techniques in parallel with typical angiography to assess the related anatomy.Multimodal imaging, including magnetic resonance angiography (MRA), computed tomographic angiography (CTA), and 3D reconstructions, was used to evaluate an incidentally discovered vascular anomaly in a 49-year-old female presenting with nonspecific neurological symptoms.Imaging revealed congenital hypoplasia of the right ICA with compensatory perfusion via an enlarged posterior communicating artery (PCOM) and anterior communicating artery (ACOM).Pronounced asymmetry between the right and left common carotid arteries (CCA) was observed, along with a small aneurysm-like irregularity along the left ICA.Vascular asymmetry may serve as a clinically valuable indicator of underlying congenital anomalies.High-resolution 3D imaging enhances detection and characterization of collateral flow patterns and supports more informed cerebrovascular risk assessment.