Case Studies| Volume 25, ISSUE 6, e98-e102, June 2016

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

      We report a very rare case of internal carotid artery (ICA) stenosis associated with persistent primitive hypoglossal artery (PPHA) treated by stenting using a proximal flow blockade and distal filter protection system. A 77-year-old man with a medical history of repeated cerebral infarction was referred to our hospital for treatment of progressive ICA stenosis. Cerebral angiography revealed that the degree of stenosis was 50% and the PPHA branched just distal to the stenosis at the C2 vertebral level. Black-blood magnetic resonance imaging indicated vulnerable plaque. The stenosis was at a high location, so carotid artery stenting was employed. Under the proximal flow blockade system with occlusion of the external and common carotid artery, distal filter protection was placed in the ICA to prevent distal embolization. A self-expanding stent was successfully deployed and the patient was discharged without any neurological deficits. In stenting for the ICA stenosis associated with PPHA, the combination of a proximal flow blockade and distal protection system is reasonable and safe.

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        • Ouriel K.
        • Green R.M.
        • DeWeese J.A.
        Anomalous carotid-basilar anastomoses in cerebrovascular surgery.
        J Vasc Surg. 1988; 7: 774-777
        • Hatayama T.
        • Yamane K.
        • Shima T.
        • et al.
        Persistent primitive hypoglossal artery associated with cerebral aneurysm and cervical internal carotid artery stenosis—case report.
        Neurol Med Chir (Tokyo). 1999; 39: 372-375
        • Lie T.A.
        Persistent carotid-basilar carotid-vertebral anastomosis, in congenital anomalies of the carotid arteries.
        Excerpta Medica, Amsterdam1968: 76-84
        • Nii K.
        • Aikawa H.
        • Tsutsumi M.
        • et al.
        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: 921-924
        • Kanazawa R.
        • Ishihara S.
        • Okawara M.
        • et al.
        Successful treatment with carotid arterial stenting for symptomatic internal carotid artery severe stenosis with ipsilateral persistent primitive hypoglossal artery: case report and review of the literature.
        Minim Invasive Neurosurg. 2008; 51: 298-302
        • Silva C.F.
        • Hou S.Y.
        • Kühn A.L.
        • et al.
        Double embolic protection during carotid artery stenting with persistent hypoglossal artery.
        J Neurointerv Surg. 2014; 6: e23
        • Zhang L.
        • Song G.
        • Chen L.
        • et al.
        Concomitant asymptomatic internal carotid artery and persistent primitive hypoglossal artery stenosis treated by endovascular stenting with proximal embolic protection.
        J Vasc Surg. 2016; 63: 237-240
        • Parodi J.C.
        • Ferreira L.M.
        • Sicard G.
        • et al.
        Cerebral protection during carotid stenting using flow reversal.
        J Vasc Surg. 2005; 41: 416-422
        • Thayer W.P.
        • Gaughen J.R.
        • Harthun N.L.
        Surgical revascularization in the presence of a preserved primitive carotid-basilar communication.
        J Vasc Surg. 2005; 41: 1066-1069