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The existence of carotid basilar anastomoses has been well documented embryologically, anatomically, and, in the case of the persistent trigeminal and hypoglossal arteries, angiographically. Conversely, anomalous origins of the vertebral arteries (VA) are not very common with an incidence ranging from 3% to 8%. Multiple variations of the VA origin have been reported in the literature, including arising from the aortic arch, from the common, internal, or external carotid arteries and subclavian branches.1 There are only four cases repor
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