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Case Reports
. 2020 Apr 13;6(2):177-180.
doi: 10.1016/j.jvscit.2020.01.016. eCollection 2020 Jun.

Critical carotid artery stenosis involving a persistent primitive hypoglossal artery

Laura B Pride  1 , Emily R Lagergren  1 , David H Hafner  1 , Arun A Chervu  1
Affiliations
Case Reports

Critical carotid artery stenosis involving a persistent primitive hypoglossal artery

Laura B Pride et al. J Vasc Surg Cases Innov Tech. .

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.

Keywords: Atherosclerosis; Carotid artery disease; Endarterectomy; Hypoglossal artery.

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Figures

Fig 1
Fig 1
Schematic of persistent fetal carotid-vertebrobasilar segmental arteries. ICA, Internal carotid artery.
Fig 2
Fig 2
Computed tomography (CT) angiography of the head and neck demonstrating two distinct severe right carotid lesions. Blue arrow, Calcific stenosis above external carotid artery-internal carotid artery (ICA) bifurcation. Yellow arrow, Ulcerated soft plaque just proximal to ICA-persistent primitive hypoglossal artery (PPHA) bifurcation. Red arrow, PPHA.
Fig 3
Fig 3
A, Three-dimensional reconstruction of computed tomography (CT) angiography image demonstrating no appreciable right-sided vertebral artery. Thick arrow, Small left vertebral artery that becomes the posterior inferior cerebellar artery. Thin arrow, Persistent primitive hypoglossal artery (PPHA). B, PPHA entering skull through the hypoglossal canal (red arrow) as the sole supply to the basilar artery.
Fig 4
Fig 4
Intraoperative image. Dashed white arrow, Carotid bulb. Solid white arrow, Persistent primitive hypoglossal artery (PPHA). Green arrow, Internal carotid artery (ICA).
See this image and copyright information in PMC

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