762 - Rare Neurovascular Variants That You Probably Have Not Seen Before

Monday, April 13, 2026

4:57 PM - 5:03 PM ET

Author/Co-author(s)

MA

Mohamad Abdalkader, MD

Associate Professor of Radiology at Boston Medical Center
Boston Medical Center, United States

Abstract Presenter(s)

SH

Samuel Z. Hanz, MD

IR/DR Resident at Jefferson Einstein Philadelphia Hospital
Jefferson Einstein Philadelphia Hospital and Boston Medical Center, United States

Author/Co-author(s)

ER

Eytan Raz, MD, PhD

Associate Professor of Radiology and Neurosurgery at NYU
NYU, United States
MZ

Marialuisa Zedde, MD

Vascular neurologist and neurosonologist
Azienda nità Sanitaria Locale-IRCCS di Reggio Emilia, Italy
WH

Wei Hu, MD

Medical Doctor
Department of Neurology and Stroke Center, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China, China (People's Republic)
RP

Rosario Pascarella, MD

Head of the Department of Neuroradiology
AUSL-IRCCS di Reggio Emilia, Italy
ZQ

Zhongming Qiu, MD

Vascular neurologist and neurosonologist
Azienda nità Sanitaria Locale-IRCCS di Reggio Emilia, Italy
RK

Raghid Kikano, MD

Attending physician, Neuroradiology
Lebanese American University, Lebanon
TN

Thanh Nguyen, MD

Director of Interventional Neurology/ Neuroradiology
Boston Medical Center, United States

Learning Objectives: 1. Describe rare neurovascular arterial variant anatomy using angiography and cross-sectional imaging

2. Review the relevant embryology associated with rare anatomic variants

3. Explore the associated pathologies related to these rare neurovascular arterial variants

4. Discuss the implications of rare anatomic variants on various procedural interventions based on the existing literature

Background: Per the World Stroke Organization, over 12 million new strokes occur each year worldwide {1}. Although only approximately 2.8% of those with large vessel occlusion undergo mechanical thrombectomy worldwide annually {2}, access to thrombectomy and various other neurointerventional procedures is increasing. Given that only 20-31% of people are thought to have “textbook anatomical configuration” of the intracranial arteries comprising the Circle of Willis {3}, recognition of neurovascular variants is becoming increasingly crucial for safe endovascular and neurosurgical interventions. We will review various uncommon neurovascular variants and anomalies along with their embryological development and discuss potential pathological associations and treatment implications.

Clinical Findings/Procedure Details: A pictorial review of selected neurovascular variants and anomalies is presented in this educational exhibit. These entities are divided into intracranial and extracranial findings. Intracranial findings include the infra-optic anterior cerebral artery, duplication of the posterior cerebral artery (“true fetal PCA”), duplication of the middle cerebral artery (MCA), MCA fenestration, twig-like MCA, pure arterial malformation, corkscrew basilar artery, persistent hypoglossal artery, persistent trigeminal artery and its variants, and aberrant internal carotid artery (ICA). Extracranial findings include the ascending pharyngeal artery arising from the ICA, thyroidal arteries from the common carotid/brachiocephalic artery, and arteria thyroidea ima. The angiographic findings of these entities are presented with their associated 3D reconstruction and multimodal cross-sectional imaging when available.

Conclusion and/or Teaching Points: This educational exhibit highlights uncommon neurovascular variants and anomalies in a pictorial review that warrant increased awareness among neuroradiologists, neurointerventionalists, and neurosurgeons to improve accurate diagnoses and safe interventions. Current literature pertaining to the associated neurovascular pathology and implications for management is discussed.