Duplicated Vertebral Artery and Implications for Surgical Planning and Endovascular Procedures

Introduction Variations in the vertebral artery (VA) origin and course, though uncommon, carry significant clinical implications, particularly in cerebrovascular surgery, stroke management, and endovascular interventions.Duplication of the VA is among the rarest anomalies, where one branch arises from the thyrocervical trunk (TCT)—a major arterial branch of the subclavian artery supplying the inferior thyroid artery, suprascapular artery, and transverse cervical artery. This anatomical variant can significantly affect cerebral hemodynamics, endovascular procedures, and surgical planning in the cervical region. Strub et al. reported a case of a left‐sided duplicate vertebral artery originating from the TCT during a neurosurgical evaluation. Material and method A 51‐year‐old male with no significant past medical history presented to the emergency ward with a sudden onset of vertigo and imbalance attacks. A magnetic resonance image (MRI) reveals multiple infarctions in the left cerebellar hemisphere and the left lateral medulla (Figure 1). Upon examination, the patient was alert and conscious but had impaired cerebellar function. The patient reported a minor trauma sustained while playing football the previous day. Cerebral angiography revealed a total occlusion of the left VA in the V2 segment. On the right side, a duplicated vertebral artery was observed. The first, hypoplastic VA originated from the subclavian artery and terminated in the mid‐cervical region. The second VA originated from the TCT and terminated at the level of the right posterior inferior cerebellar artery (PICA). Right and left carotid angiography demonstrated a bilateral fetal posterior communicating artery, supplying the basilar artery in a retrograde fashion (Figure 2). Dual antiplatelet therapy was initiated and continued for three months Discussion The VA develops from the longitudinal anastomosis of the first six intersegmental arteries from the dorsal aorta. Normally, these intersegmental arteries regress, resulting in a single VA with a subclavian origin. The most frequent variation observed bilaterally involved a variant origin proximal to the typical vertebral artery origin, with entry at the C5 level. Furthermore, multiple origins were more commonly observed on the right side.Variations in the vertebral artery (VA), particularly duplications with origins from the thyrocervical trunk (TCT), are clinically significant due to their impact on cerebrovascular interventions and surgical procedures. Conclusion A duplicated vertebral artery originating from the thyrocervical trunk is a rare yet clinically significant vascular anomaly. Advanced imaging techniques such as CTA and angiography are essential for accurately identifying such anomalies. Figure 1: Axial MRI of the cerebellar section showed multiple infarctions of the left cerebellar hemisphere and left side lateral medulla. Figure 2: Angiography of cerebral and cervical arteries.a and b: Right and left ICA angiography showing basilar supply from posterior communicating arteries retrogradely.C: An oblique view of the left vertebral artery that showed total occlusion in the cervical part.d and e; AP and f lateral view of the right subclavian artery showed a hypoplastic vertebral artery that terminates in the cervical region and an accessory or duplicate vertebral artery from the thyrocervical trunk that ends up in the level of the posterior inferior cerebellar artery.