A 2-year-old Warmblood gelding was presented with a history of bilateral feed material
coming from the nostrils secondary to dysphagia, coughing and impairment of physical
development, since purchase at 6 months of age. Endoscopy of the right guttural pouch
was unremarkable; however, in the left guttural pouch, a distended (aneurysm), pulsating,
tortuous elongated internal carotid artery (ICA) was observed. Computed tomography
revealed that in the dorsal aspect of the medial compartment of the left guttural
pouch adjacent to the jugular foramen, the ICA turned anti-clockwise creating a small
loop of 1 cm diameter. This loop had a faint linear, soft tissue attenuating connection
to the caudodorsal wall of the guttural pouch and was slightly larger in diameter
compared to the right ICA. A malformation of the left ICA was diagnosed, most likely
congenital. A secondary compression and neuropathy of one or multiple nerves of the
associated lower cranial nerves in the neurovascular plica (IX, X) was suspected explaining
the clinical signs of dysphagia. The slightly larger diameter of the left ICA could
represent congestion of the vessel or an early aneurysm formation. Based on these
findings, endovascular balloon occlusion (nondetachable balloon) of the left ICA was
performed to relief the compression on the affected nerves. The occlusion of the ICA
resolved the clinical signs within 7 weeks after surgery.
