The persistence of the hypoglossal artery (PHA) into adulthood is a very rare vascular anomaly and, when present, provides the only vascular supply to the posterior circulation. We describe a case of a 64-year-old male presenting with symptoms of vertebro-basilar insufficiency associated with severe high grade stenosis of a persistent hypoglossal artery and tandem stenosis of the proximal ipsilateral internal carotid artery (ICA), both treated by an endovascular approach. Given this patient's comorbidities and the potential anatomic difficulties presented by the PHA during performance of a carotid endarterectomy, we decided to proceed with stent placement in both the proximal ICA and the PHA in the same treatment setting. The high degree of stenosis in the PHA and the presence of a large atherosclerotic plaque in the proximal ICA were felt to be good indications for proximal embolic protection by a flow-reversal technique using the GORE Flow Reversal System (W.L.Gore and Associates, Inc., Flagstaff, AZ). The unique anatomical and technical challenges associated with this case are reviewed in detail. Post-operatively, the patient improved clinically, remaining with minimal subjective right sided numbness and he was discharged home on ASA, Effient and Crestor. The patient had no complications related to the endovascular procedure.
Competing interests J Eller: None. S Jahshan: None. T Dumont: None. P Kan: None. E Levy: Stent Assisted Recanalization in Acute Ischemic Stroke—SARIS, Boston Scientific, Codman & Shurtleff, ev3/Covidien Vascular Therapies. Scientific Advisors to Codman and Shurtleff, ev3/Covidien Vascular Therapies, TheraSyn Sensors Inc., Intratech Medical Ltd., Mynx/Access Closure. Fees for carotid stenting training from Abbott Vascular, Fees for carotid stenting training from ev3/Covidien Vascular Therapies. A Siddiqui: National Institutes of Health (co-investigator NINDS 1RO1NS064592-01A1 Hemodynamic Induction of pathologic remodeling leading to intracranial aneurysms, Research Development Award from University at Buffalo. Codman & Shurtleff, Inc, Concentric Medical, ev3/Covidien Vascular Therapies, GuidePoint Global Consulting, Penumbra. Genentech. Abbott Vascular, American Association of Neurological Surgeons courses.
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