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Yoshida S, Kamatani K, Takigawa K, Tashiro N, Hashiguchi Y, Yasaka M, Aikawa H, Go Y, Kazekawa K. Strategy of cerebral endovascular treatment for cervical internal carotid artery stenosis with a persistent primitive hypoglossal artery. Surg Neurol Int 2023; 14:308. [PMID: 37810314 PMCID: PMC10559564 DOI: 10.25259/sni_567_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/11/2023] [Indexed: 10/10/2023] Open
Abstract
Background Persistent primitive hypoglossal artery (PPHA) is a rare residual arterial anastomosis. We placed a CASPER stent using Spider FX as an embolic protection device (EPD) in a patient with internal carotid artery (ICA) stenosis and PPHA. There are no reports of carotid artery stenting (CAS) using a CASPER stent for ICA stenosis with PPHA. We report the EPD strategy used in this case and the usefulness and precautions of CASPER stent insertion for cervical ICA stenosis in association with PPHA. Methods A 9Fr sheath was placed in the right femoral artery and a 9Fr Branchor balloon guide catheter was guided to the common carotid artery. A Spider FX was placed proximal to the bifurcation of the ICA and the PPHA. A 10 mm × 20 mm CASPER stent was deployed at the site of the stricture with no postoperative ischemic complications. Results There was no intra-stent occlusion, stenosis, or plaque protrusion immediately after surgery, and no postoperative ischemic complications were observed. Conclusion CASPER stent deployment with the Spider FX in the ICA and PPHA bifurcation can be considered to be an effective treatment method for ICA stenosis associated with PPHA. However, care should be taken in selecting the appropriate EPDs and stents depending on the location of the stenosis and bifurcation of the PPHA.
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Affiliation(s)
- Shinichiro Yoshida
- Department of Neurosurgery, Fukuoka Neurosurgical Hospital, Fukuoka, Japan
| | - Kaisei Kamatani
- Department of Neurosurgery, Fukuoka Neurosurgical Hospital, Fukuoka, Japan
| | - Kousuke Takigawa
- Department of Neurosurgery, Fukuoka Neurosurgical Hospital, Fukuoka, Japan
| | - Noriaki Tashiro
- Department of Cerebrovascular Medicine, Fukuoka Neurosurgical Hospital, Fukuoka, Japan
| | - Yoshiya Hashiguchi
- Department of Cerebrovascular Medicine, Fukuoka Neurosurgical Hospital, Fukuoka, Japan
| | - Masahiro Yasaka
- Department of Cerebrovascular Medicine, Fukuoka Neurosurgical Hospital, Fukuoka, Japan
| | - Hiroshi Aikawa
- Department of Neurosurgery, Fukuoka Neurosurgical Hospital, Fukuoka, Japan
| | - Yoshinori Go
- Department of Neurosurgery, Fukuoka Neurosurgical Hospital, Fukuoka, Japan
| | - Kiyoshi Kazekawa
- Department of Neurosurgery, Fukuoka Neurosurgical Hospital, Fukuoka, Japan
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Wan Z, Liu T, Xu N, Liu Q, Yu X, Wang H. Concurrence of multiple aneurysms, extreme coiling of the extracranial internal carotid artery and ipsilateral persistent primitive hypoglossal artery: A case report and literature review. Front Neurol 2022; 13:1053704. [PMID: 36545399 PMCID: PMC9760743 DOI: 10.3389/fneur.2022.1053704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/15/2022] [Indexed: 12/07/2022] Open
Abstract
Background The primitive hypoglossal artery (PHA) is an anastomotic vessel of the carotid-basilar artery system that is prevalent only transiently during the embryonic period. Persistent primitive hypoglossal artery (PPHA) is a rare vessel variation in which PHA exists persistently in adulthood and occurs in approximately 0.02-0.1% of the population. Tortuosity of the extracranial internal carotid artery (ICA) is relatively common, impacting 10-43% of the population, and is caused by either congenital or acquired factors. It is still unknown whether PPHA and tortuosity of extracranial ICA are associated. Here, we present a case report of the concurrence of three types of pathologies of the carotid artery: extreme coiling of the extracranial internal carotid artery, multiple aneurysms and persistent primitive hypoglossal artery. Case description A 66-year-old woman suffered intermittent headaches, dizziness and numbness of the right eyelid for 5 years. Magnetic resonance angiography performed in a local hospital reported an aneurysm of the posterior communicating artery segment of the left ICA and a left PPHA. Digital subtraction angiography conducted after admission showed a PPHA originating from the left cervical ICA and an extremely coiling segment of the ICA distal to the beginning of PPHA. Except for the aneurysm of the posterior communicating artery segment of the left ICA, multiple aneurysms were found at the coiling segment of the ICA. Conclusion To the best of our knowledge, this is the first report of PPHA accompanied by an adjacent, extremely coiling ICA. There are no reports of similar tortuous ICAs to this extent or at this position. Including aneurysms, three types of pathologies suggest their congenital origin, and a review of the literature infers the probable association of these lesions.
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Kazantsev AN, Zharova AS, Sokolova EV, Korotkikh AV. Stenting of the artery of Dr A.N. Kazantsev in the acute period of ischemic stroke. Radiol Case Rep 2022; 17:3699-3708. [PMID: 35942267 PMCID: PMC9356102 DOI: 10.1016/j.radcr.2022.07.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/04/2022] [Accepted: 07/06/2022] [Indexed: 11/24/2022] Open
Abstract
The A.N. Kazantsev artery is a vessel starting from the common carotid artery with subsequent bifurcation into 2 vessels of equal size-the internal carotid artery (ICA) and the persistent embryonic hypoglossal artery (PEHA). Until now, this artery has been considered as the ICA. However, according to all existing classifications, the ICA in the cervical segment does not have arterial branches. In addition, in view of the comparable sizes of PEHA and ICA, PEHA itself cannot be considered a branch of the ICA. Thus, by the right of the first description, the authors of the article named this vascular formation as the A.N. Kazantsev artery, which forms a bifurcation of the PEHA and ICA. In this clinical case, carotid angioplasty (CAS) was performed with stenting of 80% stenosis of the A.N. Kazantsev artery in the most acute period of acute cerebrovascular accident (ACV). According to angiography, the following was also revealed: the presence of PEHA, extending from the A.N. Kazantsev artery 5 cm above its mouth, connecting with the main artery; stenosis of the right vertebral artery 60% at the mouth; hypoplastic left vertebral artery with aplasia of the V4 segment; open circle of Willis (VC): absence of both posterior communicating arteries (PCA). Due to the high risk of recurrent CVA due to clamping of the A.N. Kazantsev artery during CEA, a multidisciplinary consultation decided to implement an emergency CAS of the A.N. Kazantsev artery. The distal embolism protection system FilterWire was inserted into the proximal part of the basilar artery through the radial artery on the left. The distal embolism protection system RX Accunet was inserted into the distal parts of the left ICA through the left common femoral artery. According to Seldinger, an Acculink stent 7-10 × 30 mm was inserted into the affected area of the A.N. Kazantsev artery, positioned and opened. The postoperative period was uneventful. ACV did not recur. Conducted dual antiplatelet therapy (acetylsalicylic acid 125 mg in the afternoon + clopidogrel 75 mg in the morning). The patient was discharged from the institution on the 10th day after the operation in a satisfactory condition.
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Affiliation(s)
- Anton N Kazantsev
- Kostroma regional clinical hospital named after E.I. Korolev, Kostroma, Russian Federation
| | - Alina S Zharova
- North-Western State Medical University. I.I. Mechnikov, St. Petersburg, Russian Federation
| | - Ekaterina V Sokolova
- North-Western State Medical University. I.I. Mechnikov, St. Petersburg, Russian Federation
| | - Alexander V Korotkikh
- Clinic of Cardiac Surgery of the Amur State Medical Academy of the Ministry of Health of Russia, Blagoveshchensk, Russian Federation
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Shchanitsyn IN, Larin IV, Titova II, Sazonova NV, Sumin DI, Ionova TA, Bazhanov SP, Lobkov DV. Surgical treatment in symptomatic stenosis of the carotid artery and persistent primitive hypoglossal artery. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2021; 27:159-168. [PMID: 34166357 DOI: 10.33529/angio2021220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Persistent primitive hypoglossal artery is a rare variant of intrauterine anastomosis between the carotid and basilar arteries, which may remain in adults. The presence of this artery in carotid artery atherosclerosis increases the risks for stroke in the carotid and basilar basins. Our clinical case illustrates successful carotid endarterectomy in the presence of an ipsilateral persistent primitive hypoglossal artery under cerebral oximetry control.
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Affiliation(s)
- I N Shchanitsyn
- Neurosurgical Department, Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery, V.I. Razumovsky Saratov State Medical University of the RF Ministry of Public Health, Saratov, Russia
| | - I V Larin
- Department of Roentgenoendovascular Methods of Diagnosis and Treatment, Regional Clinical Hospital, Saratov, Russia
| | - Iu I Titova
- Neurosurgical Department, Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery, V.I. Razumovsky Saratov State Medical University of the RF Ministry of Public Health, Saratov, Russia
| | - N V Sazonova
- Neurosurgical Department, Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery, V.I. Razumovsky Saratov State Medical University of the RF Ministry of Public Health, Saratov, Russia
| | - D Iu Sumin
- Neurosurgical Department, Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery, V.I. Razumovsky Saratov State Medical University of the RF Ministry of Public Health, Saratov, Russia
| | - T A Ionova
- Neurosurgical Department, Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery, V.I. Razumovsky Saratov State Medical University of the RF Ministry of Public Health, Saratov, Russia
| | - S P Bazhanov
- Neurosurgical Department, Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery, V.I. Razumovsky Saratov State Medical University of the RF Ministry of Public Health, Saratov, Russia
| | - D V Lobkov
- Neurosurgical Department, Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery, V.I. Razumovsky Saratov State Medical University of the RF Ministry of Public Health, Saratov, Russia
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Burgard M, Psathas E, Mordasini P, Medlin F, Menth M, Egger B, Oscar Mayer D. Symptomatic internal carotid artery stenosis in the presence of a persistent primary hypoglossal artery. Vascular 2020; 29:543-549. [PMID: 33175663 DOI: 10.1177/1708538120966514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Anatomic variations of the extracranial carotid artery are rare. Persistent primitive hypoglossal artery appears with a reported incidence between 0.03% and 0.2%. We report a case of recurrent transient ischemic attacks originating from proximal internal carotid artery stenosis associated with ipsilateral persistent primitive hypoglossal artery and give a review of the existing literature. METHODS A 78-year-old patient with a medical history of two previous transient ischemic attacks consulted our emergency department with an acute left hemispheric stroke. Intravenous thrombolysis permitted complete resolution of symptoms. Concurrent Computed Tomography (CT) and Magnetic Resonance (MR) angiography revealed an unstable plaque causing 50% stenosis of the left internal carotid artery with a persistent primitive hypoglossal artery dominantly perfusing the posterior circulation, and bilateral hypoplastic vertebral arteries. RESULTS Uneventful carotid artery stenting using a proximal protection device was performed, and the patient was discharged after 12 days. Six months follow-up was uneventful with a patent stent in the internal carotid artery. CONCLUSIONS Treatment of symptomatic carotid artery stenosis in the presence of persistent primitive hypoglossal artery is challenging. Management should be driven by patients' co-morbidities, the anatomical localization of the lesions and local expertise. In the case of a high origin of the persistent primary hypoglossal artery, carotid artery stenting with the use of a proximal cerebral protection device is probably the preferred and simplest approach.
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Affiliation(s)
- Marie Burgard
- Department of Surgery, Vascular Surgery Unit, HFR Fribourg - Cantonal Hospital, Fribourg, Switzerland
| | - Emmanouil Psathas
- Department of Surgery, Vascular Surgery Unit, HFR Fribourg - Cantonal Hospital, Fribourg, Switzerland
| | - Pasquale Mordasini
- University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern Inselspital, Bern, Switzerland
| | - Friedrich Medlin
- Department of Internal Medicine, Neurology Unit, HFR Fribourg - Cantonal Hospital, Fribourg, Switzerland
| | - Markus Menth
- Department of Surgery, Vascular Surgery Unit, HFR Fribourg - Cantonal Hospital, Fribourg, Switzerland
| | - Bernhard Egger
- Department of Surgery, Vascular Surgery Unit, HFR Fribourg - Cantonal Hospital, Fribourg, Switzerland
| | - Dieter Oscar Mayer
- Department of Surgery, Vascular Surgery Unit, HFR Fribourg - Cantonal Hospital, Fribourg, Switzerland
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Critical carotid artery stenosis involving a persistent primitive hypoglossal artery. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:177-180. [PMID: 32322770 PMCID: PMC7160526 DOI: 10.1016/j.jvscit.2020.01.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/30/2020] [Indexed: 11/23/2022]
Abstract
Persistent primitive hypoglossal artery (PPHA) is a rare internal carotid-vertebrobasilar anatomic variant. Awareness of this anomaly and its propensity for atherosclerotic disease is important to avoid misinterpretation of diagnostic studies and to allow appropriate interventional planning. As the predominant vascular supply to the anterior and posterior cerebral circulation, its luminal compromise can lead to devastating ischemic complications. Carotid endarterectomy and carotid stenting have both been performed to treat lesions involving a PPHA. Herein, we report a case of carotid endarterectomy involving a PPHA and discuss the clinical and surgical implications of a carotid lesion in the presence of a PPHA.
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Patira R, Kyper C, Shah P, Erkmen K. Bilateral persistent primitive hypoglossal arteries associated with unilateral symptomatic carotid thromboembolism. J Radiol Case Rep 2017; 11:1-9. [PMID: 28567180 DOI: 10.3941/jrcr.v11i4.3010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We report the fifth case of bilateral persistent primitive hypoglossal arteries in the literature. This is also the first such case to be demonstrated on computerized tomography angiogram (CTA) and the first case to be associated with a symptomatic carotid thrombus. The sub-occlusive thrombus was distal to the take-off of the dominant persistent hypoglossal artery (PHA) from the internal carotid artery, thus sparing involvement of posterior circulation. Timely identification of the internal carotid artery thromboembolism in the setting of a PHA is important to allow for thrombectomy. Any intervention was not done in this case as the patient was out of the window and at an additional risk of inducing intracranial thromboembolism. Symptomatic carotid stenosis at the PHA take-off is typically treated with endovascular angioplasty and stenting due to the typically high level of the bifurcation in the neck.
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Affiliation(s)
- Riddhi Patira
- Department of Neurology, Temple University Hospital, Philadelphia, USA
| | - Christopher Kyper
- Lewis Katz School of Medicine at Temple University, Philadelphia, USA
| | - Pallav Shah
- Department of Radiology, Temple University Hospital, Philadelphia, USA
| | - Kadir Erkmen
- Department of Neurosurgery, Temple University Hospital, Philadelphia, USA
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Ryu B, Anami H, Ishikawa T, Inoue T, Sugiura M, Kawamata T. Extremely rare persistent primitive artery passing through the jugular foramen with symptomatic ipsilateral carotid artery stenosis. Acta Neurochir (Wien) 2016; 158:1925-9. [PMID: 27473392 DOI: 10.1007/s00701-016-2896-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 07/11/2016] [Indexed: 10/21/2022]
Abstract
Primitive arteries are persistent fetal anastomoses between the carotid and vertebral-basilar circulation. Although rare, persistent primitive arteries can remain at birth. A 73-year-old woman presented with cerebral infarction to the posterior circulation caused by symptomatic common carotid artery stenosis with an unnamed and extremely rare persistent primitive artery. This anomalous vessel branched from the extracranial internal carotid artery and passed through the ipsilateral jugular foramen into the posterior cranial fossa and merged into the basilar artery. To our knowledge, this is the first case of a persistent primitive artery passing through the jugular foramen with symptomatic common carotid artery stenosis.
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