A Successful Treatment with Carotid Arterial Stenting for Symptomatic Internal Carotid Artery Severe Stenosis with Ipsilateral Persistent Primitive Hypoglossal Artery: Case Report and Review of the Literature

Abstract

A 68-year-old male presented with a syncopal attack subsequent to acute myocardial infarction. His ultrasonographic and radiological examination revealed severe left internal carotid artery (ICA) stenosis and the presence of a persistent primitive hypoglossal artery (PPHA) immediately distal to the stenosis. The bilateral anterior and left middle cerebral arteries, and the vertebrobasilar system were opacified via the stenotic ICA. Carotid arterial stenting was selected as the treatment method because the lesion was high and a shunt placement during carotid endarterectomy was considered to be technically difficult. A self-expanding stent was successfully deployed with flow control, and the patient was discharged six days after surgery without any neurological deficit. There are sixteen reported cases including ours of PPHA associated with ICA stenosis presenting with ischemic attacks of the vertebrobasilar system. To the best of our knowledge, the current case is the first report of a cervical ICA stenosis with ipsilateral carotid-basilar anastomosis treated with carotid arterial stenting.

carotid arterial stenting - persistent primitive hypoglossal artery - cervical internal carotid artery stenosis

References

• 1 Conforto AB, de Souza M, Puglia P. et al . Bilateral occipital infarcts associated with carotid atherosclerosis and a persistent hypoglossal artery.  Clin Neurol Neurosurg. 2007;  109 364-367
• 2 Hatayama T, Yamane K, Shima T. et al . Persistent primitive hypoglossal artery associated with cerebral aneurysm and cervical internal carotid artery stenosis – case report.  Neurol Med Chir (Tokyo). 1999;  39 372-375
• 3 Katoh M, Kamiyama H, Kobayashi N. et al . Severe stenosis of the internal carotid artery presenting as loss of consciousness due to the presence of a primitive hypoglossal artery: a case report.  Surg Neurol. 1999;  51 310-312
• 4 MacCartney SF, Ricci MA, Labreque P. et al . Persistent hypoglossal artery encountered during carotid endarterectomy.  Ann Vasc Surg. 1989;  3 257-260
• 5 Momma F, Ohara S, Ohyama T. Persistent trigeminal artery associated with brainstem infarct – case report.  Neurol Med Chir (Tokyo). 1992;  32 289-291
• 6 Stern J, Correll JW, Bryan N. Persistent hypoglossal artery and persistent trigeminal artery presenting with posterior fossa transient ischemic attacks. Report of two cases.  J Neurosurg. 1978;  49 614-619
• 7 Sunada I, Yamamoto S, Matsuoka Y. et al . Endarterectomy for persistent primitive hypoglossal artery – case report.  Neurol Med Chir (Tokyo). 1991;  31 104-108
• 8 Thayer WP, Gaughen JR, Harthun NL. Surgical revascularization in the presence of a preserved primitive carotid-basilar communication.  J Vasc Surg. 2005;  41 1066-1069
• 9 Parodi JC, Schönholz C, Parodi FE. et al . Initial 200 cases of carotid artery stenting using a reversal-of-flow cerebral protection device.  J Cardiovasc Surg (Torino). 2007;  48 117-124
• 10 Fantini GA, Reilly LM, Stoney RJ. Persistent hypoglossal artery: diagnostic and therapeutic considerations concerning carotid thromboendarterectomy.  J Vasc Surg.. 1994;  20 995-999
• 11 Pinkerton JA, Davidson KC, Hibbard BZ. Primitive hypoglossal artery and carotid endarterectomy.  Stroke. 1980;  11 658-660
• 12 Rodan BA, Osborne DR, Bean WJ. The persistent hypoglossal artery in ischemic intracranial cerebral vascular disease.  J Fla Med Assoc. 1985;  72 357-359
• 13 Bertoletti BG, Bartolucci R, Rabitti G. Combined internal carotid and primitive hypoglossal artery endarterectomy.  J Cardiovasc Surg. 2000;  41 653-654
• 14 Cartier R. Combined internal carotid and hypoglossal artery endarterectomies in a symptom-free patient with contralateral internal carotid artery occlusion.  J Vasc Surg.. 1995;  22 120-122
• 15 Ouriel K, Green MR, DeWeese AJ. Anomalous carotid-basilar anastomosis in cerebrovascular surgery.  J Vasc Surg. 1988;  7 774-777
• 16 Tanaka H, Takahashi H, Ishijima B. et al . A case of transient cerebral ischemia of the vertebrobasilar system caused by carotid ulcerative lesion and persistent proatlantal intersegmental artery: a case report.  No Shinkei Geka. 1987;  15 341-347 , [in Japanese]
• 17 Grego F, Stramana R, Lepidi S. et al . Primitive proatlantal intersegmental artery and carotid endarterectomy.  J Vasc Surg. 2004;  39 691
• 18 Bour P, Bracard S, Frisch N. et al . Persistent proatlantal artery associated with carotid artery stenosis treatment by percutaneous transluminal balloon angioplasty.  Ann Vasc Surg. 1991;  5 38-40
• 19 Heeney DJ, Koo AH. Bilateral cortical blindness associated with carotid stenosis in a patient with a persistent trigeminal artery: case report.  J Neurosurg. 1980;  52 709-711
• 20 Kolbinger R, Heindel W, Pawlik G. et al . Right proatlantal artery type I, right internal carotid occlusion, and left internal carotid stenosis: case report and review of the literature.  J Neurol Sci. 1993;  117 232-239
• 21 Lewis VL, Cail WS. Persistent trigeminal artery with internal carotid artery occlusion.  Neurosurgery. 1983;  13 314-315
• 22 Mori T, Fukuoka M, Kazita K. et al . Percutaneous transluminal angioplasty using kissing balloon technique for carotid bifurcation stenosis coupled with the proatlantal intersegmental artery: a case report.  Minim Invasive Neurosurg. 1998;  41 214-216
• 23 Sutherland GR, Donaldson AA. Persistent hypoglossal artery complicated by internal carotid artery stenosis.  Clin Radiol. 1972;  23 222-224

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