Purpose We discuss the endovascular technique used in treating a critical stenosis of a persistent hypoglossal artery with angioplasty and stenting, as well as the anatomy of this rare variant using CT, MRA, biplanar and 3D DSA, and DynaCT.
Case Report A 63-year-old Hispanic male presented to the E.R. with a chief complaint of blurred vision and dizziness for 2 days. Past medical history was significant for hypertension, diabetes and hyperlipidemia.
Imaging Findings CT and MRI showed multiple areas of acute ischemia involving both occipital lobes and the right cerebellar hemisphere. The CT also showed an enlarged right hypoglossal canal. MRA and DSA revealed an anomalous vessel, arising extracranially from the cervical segment of the internal carotid artery, entering the intracranial compartment through the hypoglossal canal and supplying the basilar artery. The distal portion of this vessel, just below the basilar junction, had a critical stenosis. This critical stenosis was treated endovascularly with angioplasty and stenting, using a 3×15 mm Gateway balloon and a 4×15 mm Wingspan stent.
Summary A persistent hypoglossal artery is one of four primitive embryologic connections between the internal carotid artery and the vertebrobasilar circulation. Atherosclerotic disease of the common or the proximal internal carotid artery, or of the hypoglossal artery itself, may present with symptoms of vertebrobasilar insufficiency, or lead to infarction in the posterior circulation. To our knowledge, this represents the first case report of intracranial stenting through a persistent hypoglossal artery. The technical aspects of the endovascular treatment are addressed. We also discuss the anatomy of the persistent hypoglossal artery, using CT, MRI, MRA, biplanar and 3D DSA, and Dyna CT correlation.
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