Pharyngo-occipital artery variant arising proximal to occluded internal carotid artery: The risk of an unnecessary endarterectomy

Collateral branches originating from the cervical internal carotid artery (ICA) are rare but can have significant clinical and surgical implications. We present a case of pharyngo-occipital artery arising proximal from an occluded ICA that was missed and confused for severe stenosis of the ICA, leading to the misguided indication for carotid endarterectomy. Advanced preoperative studies allowed timely recognition of this anomaly and reconsideration of the therapeutic plan. We stress the importance of recognizing these variants by careful examination of multimodal pre-surgical exams. Awareness of these variants will allow a more precise diagnosis, and more appropriate management of patients with carotid artery disease.