Primitive Hypoglossal Artery Research Articles

Disappearing Cerebral Communicating Vessels in Embryonic Development—With a Case of Carotid-Vertebrobasilar Artery Anastomosis

In early embryonic development, anastomoses between carotid and basilar arteries occur in the primitive trigeminal, primitive otic, primitive hypoglossal, and primitive proatlantal arteries, and these anastomoses gradually disappear as the embryo continues to develop. This article reported a case of vascular anastomosis occurring between the external carotid artery and vertebral artery.

Case report: Navigating the challenges: successful mechanical thrombectomy in a case of persistent primitive hypoglossal artery

Case report: Navigating the challenges: successful mechanical thrombectomy in a case of persistent primitive hypoglossal artery

Percutaneous transluminal angioplasty for persistent primitive hypoglossal artery stenosis: illustrative case.

We report a case of symptomatic, progressive stenosis of a persistent primitive hypoglossal artery (PPHA), which was successfully treated with percutaneous transluminal angioplasty (PTA) of the origin of the PPHA. The PPHA is a type of carotid-basilar anastomosis with an incidence of 0.02% to 0.10%. It originates from the internal carotid artery (ICA), passes through the hypoglossal canal, and merges with the basilar artery. In many cases, the ipsilateral vertebral artery is hypoplastic; therefore, PPHA stenosis causes cerebral infarction in the posterior circulation territory, as in this case. The patient's right PPHA had severe and progressive stenosis; therefore, he experienced cerebral infarction despite medical treatment. Therefore, PTA for the stenosis was performed, which ceased the recurrence of cerebral infarction and dizziness by improving blood flow in the posterior circulation. Several reports have described ICA stenosis accompanied by PPHA or PPHA stenosis in patients receiving endovascular treatments. Almost all cases were nonprogressive, and the treatment procedure was stenting. However, in our case, the PPHA stenosis was progressive, and we performed PTA because the patient experienced resistance to antiplatelet drugs and had poor collateral flow.

Strategy of cerebral endovascular treatment for cervical internal carotid artery stenosis with a persistent primitive hypoglossal artery.

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. 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. There was no intra-stent occlusion, stenosis, or plaque protrusion immediately after surgery, and no postoperative ischemic complications were observed. 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.

Case of Amaurosis Fugax in the Setting of a Persistent Primitive Hypoglossal Artery Requiring Carotid Endarterectomy with Regional Anesthesia.

BACKGROUND A persistent primitive hypoglossal artery (PPHA) is a rare congenital anomaly leading to persistent carotid-basilar anastomosis. This is a report of an 83-year-old man with a PPHA presenting with amaurosis fugax of the left eye requiring carotid endarterectomy under regional anesthesia. CASE REPORT An 83-year-old man presented with 2 weeks of intermittent self-resolving visual disturbances, followed by an episode of left eye amaurosis fugax. The patient had been referred to the hospital for further investigation of symptoms 1 day following the amaurosis fugax event. Carotid Doppler ultrasound demonstrated a greater than 90% stenosis of the left internal carotid artery. Computed tomography carotid and Circle of Willis angiography confirmed a mixed, ulcerated plaque and revealed a persistent left hypoglossal artery originating from the left internal carotid artery and continuing as the basilar artery. On day 3 of admission, left carotid endarterectomy was performed under conscious sedation and regional anesthesia to permit continuous monitoring of neurological status and avoid the need for intraoperative shunting. "Permissive hypertension" by targeting a systolic blood pressure of 190 to 200 mmHg was sought for the duration of clamp time. There was no deterioration of neurological function during clamping of the carotid vessels. The patient recovered well and was discharged 2 days after surgery, with no residual neurology. CONCLUSIONS This report has presented a rare case of PPHA to highlight awareness of this congenital vascular anomaly when undertaking carotid endarterectomy.

Concurrence of multiple aneurysms, extreme coiling of the extracranial internal carotid artery and ipsilateral persistent primitive hypoglossal artery: A case report and literature review.

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. 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. 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.

A Case of Ruptured Aneurysm Arising from Basilar Artery Fenestration Accompanied by Persistent Primitive Hypoglossal Artery

A Case of Ruptured Aneurysm Arising from Basilar Artery Fenestration Accompanied by Persistent Primitive Hypoglossal Artery

Persistent Primitive Hypoglossal Artery with Ipsilateral Symptomatic Carotid Artery Stenosis and Cerebral Aneurysm

ObjectivePersistent 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 presentationA 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. ConclusionThe treatment strategy should be carefully considered depending on the specific blood circulation for such cases of PPHA with unique vasculature.

Surgical treatment in symptomatic stenosis of the carotid artery and persistent primitive hypoglossal artery.

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.

Carotid artery stenting with persistent primitive hypoglossal artery performed by carotid direct puncture and double distal filter protection: a case report

Carotid artery stenting with persistent primitive hypoglossal artery performed by carotid direct puncture and double distal filter protection: a case report

Critical carotid artery stenosis involving a persistent primitive hypoglossal artery

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.

Coil Embolization for Recurrent Aneurysm Associated with a Persistent Primitive Hypoglossal Artery after Clipping Surgery

Coil Embolization for Recurrent Aneurysm Associated with a Persistent Primitive Hypoglossal Artery after Clipping Surgery

Carotid artery stenting to treat internal carotid artery stenosis with persistent primitive hypoglossal artery: a case report

Carotid artery stenting to treat internal carotid artery stenosis with persistent primitive hypoglossal artery: a case report

Persistent primitive hypoglossal artery presenting with perimesencephalic nonaneurysmal subarachnoid hemorrhage: A case report and review of literature

BackgroundPersistent primitive hypoglossal artery (PPHA) is a rare remnant of the congenital carotid-basilar artery anastomosis, sometimes associated with subarachnoid hemorrhage (SAH), and aneurysms are the more common cause. However, the association of PPHA with perimesencephalic nonaneurysmal subarachnoid hemorrhage (PNSAH) is extremely rare. This report is the first to describe the occurrence of PNSAH concerning PPHA. Case descriptionA 53-year-old man suffered from subarachnoid hemorrhage with a sudden severe headache. An emergency brain computed tomography (CT) disclosed a perimesencephalic pattern of SAH. CT angiography (CTA) revealed a right PPHA entering the posterior fossa through the right enlarged hypoglossal canal. No source of the hemorrhage was identified in the imaging examinations, even with the performance of a 4-vessel angiography. ConclusionWe present a case of PPHA associated with PNSAH and review the literature. The main cause for the PPHA related to SAH is an aneurysm. The four vessels angiography helped rule out an aneurysm that is associated with a poorer prognosis and requires immediate active management. It is, therefore, essential for physicians to be aware of the increased incidence of aneurysms in PPHA to make the correct diagnosis.

Successful treatment for embolic cerebral infarction of multiple major arteries in the setting of persistent primitive hypoglossal artery: A case report

Successful treatment for embolic cerebral infarction of multiple major arteries in the setting of persistent primitive hypoglossal artery: A case report

Diagnosis of variants of carotid-vertebasilar anastomoses on MR angiography

Objective To explore the feature of embryonic communication between the carotid and vertebro-basilar system using MRA of head and neck on MR. Methods The MRA images from 7 246 consecutive patients in Liaocheng People's hospital between June 2009 and December 2015 were retrospectively reviewed. The feature of embryonic communication between internal carotid, external carotid artery and vertebro-basilar system using MRA was analyzed by two doctors. Results Forty-four cases of embryonic communication between the carotid and vertebro-basilar system were found. Thirty-nine cases of primitive trigeminal artery (PTA) and primitive trigeminal artery variants (PTAV) were detected by MRA. The prevalence of both PTA and PTAV was 0.54% (PTA, 27 cases;PTAV, 12 cases). Twenty-three cases of PTA were lateral types;four cases were medial types. All PTA originated from C4 portion of internal carotid artery, of which 27 cases connected with the basilar artery and two cases connected with the superior cerebellar artery. The region of the BA proximal to the site of convergence with the PTA was hypoplastic in seven cases and completely absent in two cases. Three cases of primitive hypoglossal artery and 2 cases of primitive proatlantal artery were detected by MRA. The prevalence of primitive hypoglossal artery and primitive proatlantal artery was 0.04% and 0.03% respectively. Two cases of primitive hypoglossal artery were from the lateral internal carotid artery and one was from the external carotid artery. It's all on the right side. One case of primitive proatlantal artery was on the left which arises from the external carotid artery, one on the right which originated from the outer part of the internal carotid artery. Thirty-four cases were coexisted with other variants of head and neck vessels. All of the primitive hypoglossal arteries were coexisted with vertebral artery absence. One case of primitive proatlantal intersegmental artery was coexisted with vertebral artery dysplasia. Eighteen cases were associated with cerebral infarctions, and three cases with aneurysm. Conclusions MRA can accurately assess the variants of carotid-vertebasilar anastomoses and have diagnostic significance. Key words: Magnetic resonance imaging; Primitive trigeminal artery; Primitive hypoglossal artery; Primitive proatlantal intersegmental artery

Persistent Primitive Hypoglossal Artery Associated with Brain Stem Ischemia in na Elderly Patient

Persistent Primitive Hypoglossal Artery Associated with Brain Stem Ischemia in na Elderly Patient

Bilateral persistent primitive hypoglossal arteries associated with unilateral symptomatic carotid occlusion (P1.298)

Bilateral persistent primitive hypoglossal arteries associated with unilateral symptomatic carotid occlusion (P1.298)

Carotid Artery Stenting for Symptomatic Stenosis of the Cervical Carotid Artery Associated with Persistent Primitive Hypoglossal Artery: A Case Report

Carotid Artery Stenting for Symptomatic Stenosis of the Cervical Carotid Artery Associated with Persistent Primitive Hypoglossal Artery: A Case Report

A Case of Carotid Artery Stenosis Associated with Persistent Primitive Hypoglossal Artery Treated by Carotid Artery Stenting with Double Distal Protection Using the Jail Technique

A Case of Carotid Artery Stenosis Associated with Persistent Primitive Hypoglossal Artery Treated by Carotid Artery Stenting with Double Distal Protection Using the Jail Technique