Dear editor,
“Kissing carotids” is the term used to define an anatomical variation of the cervical carotid arteries, which are tortuous and elongated and come in close proximity at the midline. This can be retropharyngeal (extracranial) or retrosphenoid (intracranial). It is usually encountered in an asymptomatic patient during a routine head and neck examination. In cases of retropharyngeal internal carotid arteries (ICAs), presenting complaints may include dysphagia, abnormal voice, obstructive sleep apnea, or a sense of a foreign body (1,2,3). This midline approach sometimes remains unrequited as seen in unilateral cases (4). We present the case of a 55-year-old woman who complained of long standing abnormal voice and hoarseness. Contrast-enhanced computed tomography of the head showed that the bilateral cervical ICAs were in close proximity to each other in the retropharyngeal space. The minimum distance from the posterior pharyngeal walls was 1.8 mm for the right ICA and 3 mm for the left ICA (Figure 1).
Normally, although the cervical ICA has a straight course in the neck as opposed to its intracranial tortuosity, in relation to age, morphological variations are not rare, which were encountered in the form of tortuosity, kinking, or coiling with no demonstrated additive risk of stroke (1,5). However, in cases of retropharyngeal kissing carotids, tortuosity is of clinical importance because of the risk of injury during retropharyngeal intervention and anesthetic procedures. Therefore, knowledge about this variation is important and should be reported to avoid catastrophic complications.