Symptomatic stenosis of the internal carotid artery combined with persistent primitive hypoglossal artery separately forming the basilar artery (case report)

• Shevtsov Yu.N.
• Arkhipov I.S.
• Bugaeva S.R.
• Mikhailova Yu.A.
• Bykov P.M.
• Storozhenko S.Yu.
• Bobrovskaya Е.А.

Abstract

Background. The persistent primitive hypoglossal artery is an anastomosis between the internal carotid artery and the basilar artery, being a rarely encountered developmental anomaly of vessels supplying the brain. The presence of the persistent primitive hypoglossal artery in a combination with atherosclerotic stenosis of the internal carotid artery substantially increases the risk of developing vascular catastrophes and a lethal outcome. In this clinical case report, we describe a situation with successful open endarterectomy performed from the ostium of the internal carotid artery and the presence of the persistent primitive hypoglossal artery completely forming the basilar artery.

Objective. We herein present a rare clinical case concerning surgical management of a patient with significant stenosis of the internal carotid artery in a combination with the persistent primitive hypoglossal artery separately forming the basilar artery.

Patients and methods. The persistent primitive hypoglossal artery is a branch of the carotid artery, located in the canal of the hypoglossal nerve. In our patient, this artery was the only one forming the basilar artery, with both vertebral arteries being aplastic. The patient was operated on for significant stenosis of the internal carotid artery.

Conclusion. The presence of abnormal carotid-basilar anastomoses is a rare pathology most often found incidentally. Currently, there is no specific screening to identify this pathology, but once revealed, it requires thorough differential diagnosis for an appropriate therapeutic decision to be made.

Keywords:carotid endarterectomy; persistent primitive hypoglossal artery; internal carotid artery stenos; stroke; atherosclerosis