Symptomatic internal carotid artery stenosis in the presence of a persistent primary hypoglossal artery.

Burgard, Marie; Psathas, Emmanouil; Mordasini, Pasquale; Medlin, Friedrich; Menth, Markus; Egger, Bernhard; Oscar Mayer, Dieter (2021). Symptomatic internal carotid artery stenosis in the presence of a persistent primary hypoglossal artery. Vascular medicine, 29(4), pp. 543-549. Sage 10.1177/1708538120966514

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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.

Item Type:	Journal Article (Further Contribution)
Division/Institute:	04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
UniBE Contributor:	Mordasini, Pasquale Ranato
Subjects:	600 Technology > 610 Medicine & health
ISSN:	1358-863X
Publisher:	Sage
Language:	English
Submitter:	Martin Zbinden
Date Deposited:	11 Dec 2020 17:03
Last Modified:	02 Mar 2023 23:34
Publisher DOI:	10.1177/1708538120966514
PubMed ID:	33175663
Uncontrolled Keywords:	Persistent primary hypoglossal artery carotid artery stenting carotid endarterectomy stroke symptomatic carotid artery stenosis
URI:	https://boris.unibe.ch/id/eprint/148205