The Retropharyngeal Internal Carotid Artery: A Systematic Review, Meta-Analysis of the Current Literature, and Evidence Sampling.
Răzvan Costin Tudose, Andrei Darius Stan, Alexandra Diana Vrapciu et al.
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In 30 seconds
This systematic review and meta-analysis assessed the prevalence and imaging features of retropharyngeal internal carotid arteries (RP-ICAs) in adult imaging cohorts. Of 47 studies included in the qualitative review, five cohorts contributed to the pooled estimate, comprising 10,066 adults and 150 RP-ICA cases. The pooled prevalence was 1.51% (95% CI, 0.53%-4.21%), with substantial heterogeneity; individual-study estimates ranged from 0.07% to 7.97%. The oropharynx was the most frequent site, and reports described arteries close to or contacting the pharyngeal mucosa, sometimes with positional changes on serial imaging.
Key findings
- Five imaging cohorts included 10,066 adults and identified 150 RP-ICA cases.
- Pooled prevalence was 1.51% (95% CI, 0.53%-4.21%), with substantial heterogeneity.
- Individual-study prevalence estimates ranged from 0.07% to 7.97%; the oropharynx was the most frequent site.
- Some reports described RP-ICAs within a few millimeters of, or in direct contact with, pharyngeal mucosa.
Why it matters
An RP-ICA can narrow the safety margin for procedures near the pharynx, including nasotracheal intubation and transoral surgery. The pooled estimate indicates that the variant is uncommon, but the reported proximity to mucosa and positional changes underscore the value of recognizing and describing its location. More consistent imaging measurements could improve comparison between studies and communication of procedural risk.
What to keep in mind
Only five imaging cohorts contributed to the meta-analysis, and prevalence estimates showed substantial heterogeneity. The review also excluded non-English studies and studies without available full text.