Arterial Dissection of an Anomalous Right Vertebral Artery Arising From the Right Common Carotid Artery Associated With an Acute Right Middle Cerebral Artery Stroke

In rare cases, the right vertebral artery can have its origin from the right proximal common carotid artery. This anatomical variant can be incidental, but if trauma to the vertebral artery occurs, there can be devastating neurological deficits. Our patient was an adult female who initially presented with new-onset left arm weakness and dysarthria. After a CT angiogram and ultrasound imaging were performed, she was found to have an acute right middle cerebral artery (MCA) stroke in association with dissection of the anomalous right vertebral artery. The patient underwent urgent mechanical thrombectomy in the right MCA and thrombolysis in cerebral infarction (TICI) grade 3 recanalization was successfully achieved. The patient made a complete recovery with no neurological sequelae. A follow-up CT angiogram after six months showed resolution of the dissection and restored patency of the right vertebral artery.