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Nagasaki H, Narikiyo M, Ohashi S, Matsuoka H, Tsuboi Y. "Dual Internal Shunts Technique" for Carotid Endarterectomy with Carotid Vertebral Anastomosis: Technical Note. Neurol Med Chir (Tokyo) 2023; 63:490-494. [PMID: 37612119 PMCID: PMC10687672 DOI: 10.2176/jns-nmc.2023-0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/22/2023] [Indexed: 08/25/2023] Open
Abstract
In revascularization of internal carotid stenosis with carotid vertebrobasilar anastomoses, attention should be paid not only to the anterior circulation but also to the posterior circulation cerebral infarction. A 74-year-old man was referred for treatment of carotid artery stenosis; NASCET 75% stenosis in the right internal carotid artery and acute cerebral infarction were confirmed. Occlusion of the left subclavian artery and vascular anastomosis between the right external carotid artery and the vertebral artery were indicated, such that the right external carotid artery may maintain blood flow to the vertebrobasilar artery. Therefore, dual shunts were used for the common and internal carotid arteries and the common and external carotid arteries to maintain blood flow during carotid endarterectomy. Management of the dual shunts is difficult due to the instable parallel placement of the common carotid artery shunt balloons. To solve this problem, the "dual internal shunts technique" was performed. The first shunt was inserted into the external and common carotid arteries, and the second into the internal and common carotid arteries. The shunt balloon on the common carotid artery side was placed distal to the first shunt balloon so that the dual balloons were placed in a tandem position. The proximal balloon was subsequently deflated gradually to improve flow in both shunts. The procedure is technically easy and safe.
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Affiliation(s)
| | | | - So Ohashi
- Department of Neurosurgery, Kawasaki Saiwai Hospital
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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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Kawamura K, Tokugawa J, Watanabe M, Fujita N, Teramoto S, Kimura T, Ito Y, Nakao Y, Yamamoto T. Persistent Primitive Hypoglossal Artery with Ipsilateral Symptomatic Carotid Artery Stenosis and Cerebral Aneurysm. J Stroke Cerebrovasc Dis 2021; 30:106099. [PMID: 34536812 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/29/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE Persistent primitive hypoglossal artery (PPHA) is a rare type of persistent carotid-basilar anastomosis sometimes associated with other vascular lesions. We treated an extremely rare case of PPHA with concomitant ipsilateral symptomatic cervical internal carotid artery (ICA) stenosis and unruptured aneurysm. CASE PRESENTATION A 67-year-old woman visited our institution with acute onset of diplopia. Magnetic resonance imaging revealed multiple acute infarctions in the right anterior and posterior circulations. Digital subtraction angiography demonstrated the right PPHA concomitant with ipsilateral cervical ICA stenosis and an unruptured ICA aneurysm with maximum diameter of 8 mm. The multiple infarctions were considered to result from artery-to-artery embolism due to microthrombi from the ICA plaque passed along the PPHA, so carotid endarterectomy was performed as the first step with preoperative modified Rankin Scale (mRS) grade 1. During the operation, the patient had impaired ICA perfusion due to internal shunt catheter migration into the PPHA followed by acute infarction in the right hemisphere causing mild left hemiparesis. The patient was transferred to the rehabilitation hospital with mRS grade 3. After 3 months of rehabilitation, the patient recovered to mRS grade 1 and clipping surgery for the unruptured right ICA aneurysm was performed as the second step with uneventful postoperative course. CONCLUSION The treatment strategy should be carefully considered depending on the specific blood circulation for such cases of PPHA with unique vasculature.
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Affiliation(s)
- Kaito Kawamura
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan; Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan.
| | - Joji Tokugawa
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan.
| | - Mitsuya Watanabe
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan.
| | - Naohide Fujita
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan; Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan.
| | - Shinichiro Teramoto
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan; Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan.
| | - Takaoki Kimura
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan; Department of Neurosurgery, Shin-Yurigaoka General Hospital, Kawasaki, Kanagawa, Japan.
| | - Yoshitaka Ito
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan; Department of Neurosurgery, Juntendo Tokyo Koto Geriatric Medical Centre, Tokyo, Japan.
| | - Yasuaki Nakao
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan.
| | - Takuji Yamamoto
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan.
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Sanada T, Shirai W, Yamamoto S, Kinoshita M, Tokumitsu N. A case of carotid endarterectomy assisted with a three-way junction shunting tube for the internal carotid artery stenosis involving a persistent primitive hypoglossal artery. J Surg Case Rep 2021; 2021:rjab362. [PMID: 34476076 PMCID: PMC8407026 DOI: 10.1093/jscr/rjab362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 07/29/2021] [Indexed: 11/12/2022] Open
Abstract
Only several cases of internal carotid artery (ICA) stenosis involving the persistent primitive hypoglossal artery (PPHA) have been treated with carotid endarterectomy (CEA) because of its extreme rarity. CEA was performed for an 87-year-old female with severe stenosis of the right ICA–PPHA bifurcation requiring shunting from CCA to both PPHA and ICA. We initially attempted to insert two intraluminal balloon shunts into the CCA, as previously reported. However, we found this procedure technically impossible to achieve. An improvised three-way junction tube was inserted distally into PPHA and ICA and proximally into CCA, securing blood flow during CEA. Unfortunately, the patient suffered post-operative ischemic brain lesions due to the prolonged ischemic time during our initial unsuccessful shunt attempt. A three-way junction shunting tube could be an effective shunt technique during an anatomically complicated CEA.
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Affiliation(s)
- Takahiro Sanada
- Department of Neurosurgery, Nayoro City General Hospital, Nayoro, Japan
| | - Wakako Shirai
- Department of Neurosurgery, Nayoro City General Hospital, Nayoro, Japan
| | - Shota Yamamoto
- Department of Neurosurgery, Asahikawa Medical University, Asahikawa, Japan
| | - Manabu Kinoshita
- Department of Neurosurgery, Asahikawa Medical University, Asahikawa, Japan
| | - Naoki Tokumitsu
- Department of Neurosurgery, Nayoro City General Hospital, Nayoro, Japan
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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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7
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Rockley M, Ryan SE, Nagpal S. Endarterectomy of carotid artery bifurcation in the setting of a persistent hypoglossal artery and anomalous collateral vascular supply. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:520-523. [PMID: 33134634 PMCID: PMC7588749 DOI: 10.1016/j.jvscit.2020.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/05/2020] [Indexed: 12/03/2022]
Abstract
Presented is a patient with carotid artery stenosis resulting in crescendo anterior and posterior circulation transient ischemic attacks. Treatment was complicated by a rare persistent hypoglossal artery (HGA) arising from the left internal carotid artery in addition to severe contralateral carotid disease, hypoplastic vertebral arteries, and incomplete circle of Willis. A carotid endarterectomy with shunting was performed, maintaining perfusion of both the proper left internal carotid artery and HGA. This is a rare case of carotid stenosis in the setting of a persistent HGA with contralateral carotid disease and highlights the importance of planning intracranial perfusion before carotid surgery.
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Affiliation(s)
- Mark Rockley
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital-Civic Campus, Ottawa, Ontario, Canada
| | - Stephen E Ryan
- Department of Medical Imaging, University of Ottawa, The Ottawa Hospital-Civic Campus, Ottawa, Ontario, Canada
| | - Sudhir Nagpal
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital-Civic Campus, Ottawa, Ontario, Canada
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8
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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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9
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Madden NJ, Calligaro KD, Dougherty MJ, Maloni K, Troutman DA. Persistent Hypoglossal Artery: Challenges Associated With Carotid Revascularization. Vasc Endovascular Surg 2019; 53:589-592. [DOI: 10.1177/1538574419859102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Anomalous connections between the anterior and posterior cranial circulation are rare embryologic entities. A persistent hypoglossal artery has a reported incidence of 0.03% to 0.09% and has been linked to intracranial aneurysms, atherosclerosis, and posterior circulation ischemia. Identification of this anomaly is essential prior to carotid artery revascularization given the technical challenges and added risks with intervention. We report a case of an 80-year-old female with progression of carotid stenosis in the setting of a persistent hypoglossal artery. We provide a review of the literature and discuss the technical challenges of carotid revascularization in this patient.
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Affiliation(s)
- Nicholas J. Madden
- Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia, PA, USA
| | - Keith D. Calligaro
- Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia, PA, USA
| | | | - Krystal Maloni
- Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia, PA, USA
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10
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Varvari I, Bos EM, Dinkelaar W, van Es AC, Can A, Hunfeld M, Du R, Dammers R, Volovici V. Fatal Subarachnoid Hemorrhage from an Aneurysm of a Persistent Primitive Hypoglossal Artery: Case Series and Literature Overview. World Neurosurg 2018; 117:285-291. [PMID: 29940384 DOI: 10.1016/j.wneu.2018.06.119] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/12/2018] [Accepted: 06/14/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Persistent carotid-basilar connections have a prevalence of 0.14%. Recognizing such persistent fetal anastomoses between the carotid and the vertebrobasilar circulation is of great importance because they are reportedly associated with an increased prevalence of intracranial aneurysms. METHODS We report the case of a 15-year-old female patient who presented with a World Federation of Neurosurgical Societies grade 5 subarachnoid hemorrhage from an aneurysm at the junction of a persistent primitive hypoglossal artery and the posterior inferior cerebellar artery origin. Supratentorially, unfortunately, there was no parenchymal blush or cortical venous return. Eventually, a multidisciplinary decision was made to withdraw care. RESULTS Fifty-seven cases were reported in the literature to date of persistent hypoglossal arteries, 16 of which presented with an associated aneurysm, 5 with an arteriovenous malformation, and 6 with a subarachnoid hemorrhage. Our case is the youngest patient reported so far. Hypoplasia or aplasia of the vertebral artery often were encountered (36 and 13 cases, respectively), as well as carotid artery stenosis (15 cases). CONCLUSIONS Although uncommon, it is important to recognize persistent carotid-basilar connections, since they have a considerable hemodynamic impact on the posterior cerebral circulation via the carotid system. A critical reduction in the carotid blood flow will, therefore, have ischemic consequences in the posterior cerebral territories. In addition, such connections might be associated with anomalies of the vessel wall and be predisposed to aneurysm formation. The endovascular neurointerventionalist, as well as the vascular and skull base neurosurgeon, need to be aware of their anatomy and variations.
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Affiliation(s)
- Ioana Varvari
- Department of Adult Mental Health, Tees, Esk and Wear Valleys NHS Trust, United Kingdom
| | - Eelke M Bos
- Department of Neurosurgery, Erasmus MC University Medical Center, Erasmus MC Stroke Center, Rotterdam, The Netherlands
| | - Wouter Dinkelaar
- Department of Radiology, Erasmus MC University Medical Center, Erasmus MC Stroke Center, Rotterdam, The Netherlands
| | - Ad C van Es
- Department of Radiology, Erasmus MC University Medical Center, Erasmus MC Stroke Center, Rotterdam, The Netherlands
| | - Anil Can
- Department of Neurosurgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Maayke Hunfeld
- Department of Pediatric Neurology, Erasmus MC University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Rose Du
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ruben Dammers
- Department of Neurosurgery, Erasmus MC University Medical Center, Erasmus MC Stroke Center, Rotterdam, The Netherlands; Department of Pediatric Neurosurgery, Erasmus MC University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Victor Volovici
- Department of Neurosurgery, Erasmus MC University Medical Center, Erasmus MC Stroke Center, Rotterdam, The Netherlands; Department of Medical Decision Making, Erasmus MC, Rotterdam, The Netherlands.
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Vasović L, Trandafilović M, Vlajković S, Djordjević G, Daković-Bjelaković M, Pavlović M. Unilateral Aplasia versus Bilateral Aplasia of the Vertebral Artery: A Review of Associated Abnormalities. BIOMED RESEARCH INTERNATIONAL 2017; 2017:7238672. [PMID: 28932744 PMCID: PMC5592402 DOI: 10.1155/2017/7238672] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/04/2017] [Indexed: 11/18/2022]
Abstract
Morphological characteristics of 108 cases of uni- and bilateral aplasia of the vertebral artery (VA) in reports or images of retrospective studies, including one recent case, published between 1967 and 2016 are analyzed. Incidence, gender, persistence of carotid-vertebrobasilar anastomosis (CVBA), associated with other vascular variants, and vascular pathology in each group of uni- and bilateral VA aplasia are mutually compared. Most of the cases of VA aplasia in ages 31 to 80 were discovered in USA, Japan, and India. The bilateral VA aplasia is more common in the male gender than in the female one. The side of the VA aplasia had a significant effect on the side of CVBA persistence. Associated aplasia of other arteries was more common in cases of unilateral VA aplasia. The left VA was more commonly hypoplastic in cases of single right VA aplasia than the right VA in cases of single left VA aplasia. Aneurysms of definitive arteries were more frequent in cases of single right VA aplasia than in cases of single left VA aplasia. We claim that the aplasia of the VA probably depends on genetic factors in some races, while diseases are expressed usually in persons over 30 years of age.
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Affiliation(s)
- L. Vasović
- Department of Anatomy, Faculty of Medicine, University of Niš, 81 Blvd. Dr. Zoran Djindjić, 18000 Niš, Serbia
| | - M. Trandafilović
- Department of Anatomy, Faculty of Medicine, University of Niš, 81 Blvd. Dr. Zoran Djindjić, 18000 Niš, Serbia
| | - S. Vlajković
- Department of Anatomy, Faculty of Medicine, University of Niš, 81 Blvd. Dr. Zoran Djindjić, 18000 Niš, Serbia
| | - G. Djordjević
- Health Center Niš, 15 Vojvode Tankosića St., 18000 Niš, Serbia
| | - M. Daković-Bjelaković
- Department of Anatomy, Faculty of Medicine, University of Niš, 81 Blvd. Dr. Zoran Djindjić, 18000 Niš, Serbia
| | - M. Pavlović
- Department of Anatomy, Faculty of Medicine, University of Niš, 81 Blvd. Dr. Zoran Djindjić, 18000 Niš, Serbia
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Murai S, Kusaka N, Umakoshi M, Itami H, Otsuka S, Nishiura T, Ogihara K. Stenting for Internal Carotid Artery Stenosis Associated with Persistent Primitive Hypoglossal Artery Using Proximal Flow Blockade and Distal Protection System: A Technical Case Report and Literature Review. J Stroke Cerebrovasc Dis 2016; 25:e98-e102. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.03.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 03/15/2016] [Indexed: 10/21/2022] Open
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13
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Ryu B, Ishikawa T, Hashimoto K, Shimizu M, Yagi S, Shimizu T, Kawamata T. Internal carotid artery stenosis with persistent primitive hypoglossal artery treated with carotid artery stenting: A case report and literature review. Neuroradiol J 2016; 29:115-21. [PMID: 26825135 DOI: 10.1177/1971400915626427] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Persistent primitive hypoglossal artery (PPHA) is a persistent carotid-basilar anastomosis. It rarely remains at birth. It occasionally may be a risk for ischemia and embolic infarction to the posterior cerebral circulation, especially in patients with carotid stenosis proximal to the origin of persistent primitive arteries. We describe a case of a 60-year-old woman with asymptomatic internal carotid artery (ICA) stenosis and ipsilateral PPHA successfully treated by carotid artery stenting (CAS). A few cases of CAS for ICA stenosis with PPHA have been reported, but the strategy and methods in each case were different because of its unique anatomy and hemodynamics. It is essential to prevent distal embolisms and preserve blood flow at the territory of both the ICA and PPHA. The protection method should be selected carefully. We review the literature and discuss appropriate treatment strategies.
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Affiliation(s)
- Bikei Ryu
- Department of Neurosurgery, Kanto Neurosurgical Hospital, Japan Department of Neurosurgery, Tokyo Women's Medical University, Japan
| | - Tatsuya Ishikawa
- Department of Neurosurgery, Tokyo Women's Medical University, Japan
| | - Koji Hashimoto
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Japan
| | | | - Shinichi Yagi
- Department of Neurosurgery, Kanto Neurosurgical Hospital, Japan
| | - Tsuneo Shimizu
- Department of Neurosurgery, Kanto Neurosurgical Hospital, Japan
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Huang M, Moisi M, Zwillman ME, Volpi JJ, Diaz O, Klucznik R. Transient Ischemic Attack in the Setting of Carotid Atheromatous Disease with a Persistent Primitive Hypoglossal Artery Successfully Treated with Stenting: A Case Report. Cureus 2016; 8:e464. [PMID: 26929891 PMCID: PMC4762695 DOI: 10.7759/cureus.464] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Fetal brain perfusion is supplied by the primitive dorsal aorta anteriorly, longitudinal neural arteries posteriorly, and anastomotic transverse segmentals. Most notable of these connections are the primitive trigeminal, otic, hypoglossal, and proatlantal arteries. With cranial-cervical circulatory maturation and development of the posterior communicating segments and vertebro-basilar system, these primitive segmental anastomoses normally regress. Anomalous neurovascular development can result in persistence of these anastomoses. Due to its territory of perfusion, the persistent primitive hypoglossal artery (PPHA) is associated with vertebral artery and posterior communicating artery hypoplasia or aplasia. As a consequence, primary blood supply to the hindbrain comes chiefly from this single artery. Although usually clinically silent, PPHA is susceptible to common cerebrovascular disorders including athero-ischemic disease and saccular aneurysmal dilation to name a few. We present a case of transient ischemic attack in a patient with a PPHA and proximal atherosclerotic disease treated by endovascular stenting.
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Affiliation(s)
- Meng Huang
- Department of Neurosurgery, Houston Methodist Neurological Institute
| | - Marc Moisi
- Neurosurgery, Swedish Neuroscience Institute
| | | | - John J Volpi
- Neurology, Houston Methodist Neurological Institute
| | - Orlando Diaz
- Radiology, Houston Methodist Neurological Institute
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Carotid Endarterectomy in the Face of a Persistent Hypoglossal Artery. Ann Vasc Surg 2015; 29:1660.e1-4. [DOI: 10.1016/j.avsg.2015.05.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 05/27/2015] [Accepted: 05/28/2015] [Indexed: 11/20/2022]
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Yoshikawa G, Kawashima M, Tsutsumi K. Carotid endarterectomy for treatment of tandem carotid stenosis in the presence of the anomalous origin of the occipital artery arising from the cervical internal carotid artery: a case report. J Med Case Rep 2013; 7:254. [PMID: 24199618 PMCID: PMC3835444 DOI: 10.1186/1752-1947-7-254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 09/14/2013] [Indexed: 12/03/2022] Open
Abstract
Introduction Branches from the cervical portion of the internal carotid artery are rare. In most cases, atherosclerotic stenosis is found at the bifurcation of the internal and external carotid arteries. However, when associated with atherosclerotic carotid artery disease, the origin of the rare branches arising from the internal carotid artery can be another site of stenosis. This report describes a rare case of such tandem carotid stenosis treated by carotid endarterectomy and the importance of the possibility of stenosis at the origin of the anomalous branch from the internal carotid artery. Case presentation A 73-year-old Japanese woman presented with transient left hemiparesis and vertigo. Magnetic resonance angiography seemed to indicate two stenotic lesions distal to the right internal carotid artery in addition to the origin of the right internal carotid artery, and angiography indicated tandem stenotic lesions of the internal carotid artery. The patient was successfully treated with right carotid endarterectomy, including the distal stenotic lesion of internal carotid artery, and postoperative angiography indicated that the occipital artery arose from the internal carotid artery. Conclusion It is important to recognize rare cases of the anomalous origin of the occipital artery from the internal carotid artery and the possibility that the origin of such an anomalous occipital artery may be the cause of stenosis.
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Affiliation(s)
- Gakushi Yoshikawa
- Department of Neurosurgery, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira City, Tokyo 187-8510, Japan.
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Internal carotid and ipsilateral type II proatlantal artery stenoses causing simultaneous hemispheric and vertebrobasilar transient ischemia. J Vasc Surg 2010; 53:475-7. [PMID: 21050702 DOI: 10.1016/j.jvs.2010.08.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Revised: 08/04/2010] [Accepted: 08/06/2010] [Indexed: 11/21/2022]
Abstract
A case of persistent proatlantal artery (PA) is described in a 60-year-old woman who presented with cerebellar ataxia, homonymous hemianopia, and aphasia. Both Doppler scan and magnetic resonance angiography (MRA) showed agenesis of both vertebral arteries, 80% stenosis of the left internal carotid artery (ICA), and an anastomotic vessel between the left external carotid artery (ECA) and the left vertebral artery (LVA) with a tight stenosis at the origin. It was thought to be a type II PA. Both lesions were successfully treated by ICA endarterectomy and common carotid artery to PA bypass. This case demonstrates the clinical significance of persistent PA in the evolution of an ischemic cerebrovascular disease.
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NII K, AIKAWA H, TSUTSUMI M, ONIZUKA M, NAKAU H, INOUE R, GO Y, KAZEKAWA K. Carotid Artery Stenting in a Patient With Internal Carotid Artery Stenosis and Ipsilateral Persistent Primitive Hypoglossal Artery Presenting With Transient Ischemia of the Vertebrobasilar System -Case Report-. Neurol Med Chir (Tokyo) 2010; 50:921-4. [DOI: 10.2176/nmc.50.921] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kouhei NII
- Department of Neurosurgery, Fukuoka University Chikushi Hospital
| | - Hiroshi AIKAWA
- Department of Neurosurgery, Fukuoka University Chikushi Hospital
| | | | - Masanari ONIZUKA
- Department of Neurosurgery, Fukuoka University Chikushi Hospital
| | - Hiroya NAKAU
- Department of Neurosurgery, Fukuoka University Chikushi Hospital
| | - Ritsurou INOUE
- Department of Neurosurgery, Fukuoka University Chikushi Hospital
| | - Yoshinori GO
- Department of Neurosurgery, Fukuoka University Chikushi Hospital
| | - Kiyoshi KAZEKAWA
- Department of Neurosurgery, Fukuoka University Chikushi Hospital
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Baldi S, Zander T, Rabellino M, Maynar M. Stent-Assisted Coil Embolization of a Wide-Neck Aneurysm of a Persistent Primitive Hypoglossal Artery. Cardiovasc Intervent Radiol 2008; 32:352-5. [DOI: 10.1007/s00270-008-9415-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2008] [Revised: 07/18/2008] [Accepted: 07/22/2008] [Indexed: 11/24/2022]
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Conforto AB, de Souza M, Puglia P, Yamamoto FI, da Costa Leite C, Scaff M. Bilateral occipital infarcts associated with carotid atherosclerosis and a persistent hypoglossal artery. Clin Neurol Neurosurg 2007; 109:364-7. [PMID: 17224233 DOI: 10.1016/j.clineuro.2006.12.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2006] [Revised: 12/10/2006] [Accepted: 12/11/2006] [Indexed: 11/19/2022]
Abstract
The persistent hypoglossal artery (PHA) is the second most common persistent embryological carotid-basilar connection and usually represents an incidental finding in cerebral arteriograms. The hypoglossal artery connects the primordial carotid artery with the longitudinal neural arteries, which later form the basilar artery. The PHA leaves the internal carotid artery as an extracranial branch, enters the skull through the anterior condyloid foramen, the hypoglossal canal and joins the caudal portion of the basilar artery. We report magnetic resonance and digital subtraction angiography findings in the first case of bilateral occipital infarctions associated with PHA and carotid atherosclerosis. The probable mechanism underlying bilateral occipital infarcts was embolism from the carotid territory to the posterior cerebral arteries. PHA may present a challenge in diagnosis and management of patients with carotid atherosclerosis and vertebrobasilar ischemia.
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