Carotid Endarterectomy for Vertebrobasilar Insufficiency Caused by Severe Stenosis of Primitive Hypoglossal Artery: A Technical Case Report and Literature Review

Persistent primitive hypoglossal artery (PHA) originating from the external carotid artery (ECA) is a rare anomaly. Reports of carotid endarterectomy (CEA) for ECA stenosis associated with this anomaly are even rarer. A 76-year-old woman presented to a medical clinic with a major complaint of refrac...

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Bibliographic Details
Published in:Neurologia medico-chirurgica 2022/05/15, Vol.62(5), pp.254-259
Main Authors: SEGAWA, Masafumi, INOUE, Tomohiro, TSUNODA, Sho, NODA, Ryuuichi, AKABANE, Atsuya
Format: Article
Language:eng ; jpn
Subjects:
arterial anomaly
Carotid artery
carotid endarterectomy
Case reports
Cerebral infarction
Literature reviews
Magnetic resonance imaging
Neck
occipital artery
persistent primitive hypoglossal artery
Stenosis
Technical Note
vertebral artery
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Summary:Persistent primitive hypoglossal artery (PHA) originating from the external carotid artery (ECA) is a rare anomaly. Reports of carotid endarterectomy (CEA) for ECA stenosis associated with this anomaly are even rarer. A 76-year-old woman presented to a medical clinic with a major complaint of refractory dizziness. Carotid ultrasound study suggested severe stenosis of the left cervical carotid bifurcation; therefore, she was referred to our department for a possible CEA. The imaging results indicated severe stenosis of the left carotid bifurcation and that the ECA was a PHA and the origin of the dominant vertebrobasilar artery (VBA). CEA was performed with the special caution of providing VBA collateral flow during clamping and preventing microembolisms during declamping of the ECA. Postoperative head magnetic resonance imaging revealed no new findings of cerebral infarction, and her dizziness disappeared. CEA associated with stenosis of the PHA as the origin of a dominant VBA was safely performed with an appropriate understanding of possible collateral pathways during cross-clamping.
ISSN:0470-8105
1349-8029
DOI:10.2176/jns-nmc.2021-0360