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Nagasaki H, Narikiyo M, Ohashi S, Matsuoka H, Tsuboi Y. "Dual Internal Shunts Technique" for Carotid Endarterectomy with Carotid Vertebral Anastomosis: Technical Note. Neurol Med Chir (Tokyo) 2023; 63:490-494. [PMID: 37612119 PMCID: PMC10687672 DOI: 10.2176/jns-nmc.2023-0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/22/2023] [Indexed: 08/25/2023] Open
Abstract
In revascularization of internal carotid stenosis with carotid vertebrobasilar anastomoses, attention should be paid not only to the anterior circulation but also to the posterior circulation cerebral infarction. A 74-year-old man was referred for treatment of carotid artery stenosis; NASCET 75% stenosis in the right internal carotid artery and acute cerebral infarction were confirmed. Occlusion of the left subclavian artery and vascular anastomosis between the right external carotid artery and the vertebral artery were indicated, such that the right external carotid artery may maintain blood flow to the vertebrobasilar artery. Therefore, dual shunts were used for the common and internal carotid arteries and the common and external carotid arteries to maintain blood flow during carotid endarterectomy. Management of the dual shunts is difficult due to the instable parallel placement of the common carotid artery shunt balloons. To solve this problem, the "dual internal shunts technique" was performed. The first shunt was inserted into the external and common carotid arteries, and the second into the internal and common carotid arteries. The shunt balloon on the common carotid artery side was placed distal to the first shunt balloon so that the dual balloons were placed in a tandem position. The proximal balloon was subsequently deflated gradually to improve flow in both shunts. The procedure is technically easy and safe.
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Affiliation(s)
| | | | - So Ohashi
- Department of Neurosurgery, Kawasaki Saiwai Hospital
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Kazantsev AN, Zharova AS, Sokolova EV, Korotkikh AV. Stenting of the artery of Dr A.N. Kazantsev in the acute period of ischemic stroke. Radiol Case Rep 2022; 17:3699-3708. [PMID: 35942267 PMCID: PMC9356102 DOI: 10.1016/j.radcr.2022.07.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/04/2022] [Accepted: 07/06/2022] [Indexed: 11/24/2022] Open
Abstract
The A.N. Kazantsev artery is a vessel starting from the common carotid artery with subsequent bifurcation into 2 vessels of equal size-the internal carotid artery (ICA) and the persistent embryonic hypoglossal artery (PEHA). Until now, this artery has been considered as the ICA. However, according to all existing classifications, the ICA in the cervical segment does not have arterial branches. In addition, in view of the comparable sizes of PEHA and ICA, PEHA itself cannot be considered a branch of the ICA. Thus, by the right of the first description, the authors of the article named this vascular formation as the A.N. Kazantsev artery, which forms a bifurcation of the PEHA and ICA. In this clinical case, carotid angioplasty (CAS) was performed with stenting of 80% stenosis of the A.N. Kazantsev artery in the most acute period of acute cerebrovascular accident (ACV). According to angiography, the following was also revealed: the presence of PEHA, extending from the A.N. Kazantsev artery 5 cm above its mouth, connecting with the main artery; stenosis of the right vertebral artery 60% at the mouth; hypoplastic left vertebral artery with aplasia of the V4 segment; open circle of Willis (VC): absence of both posterior communicating arteries (PCA). Due to the high risk of recurrent CVA due to clamping of the A.N. Kazantsev artery during CEA, a multidisciplinary consultation decided to implement an emergency CAS of the A.N. Kazantsev artery. The distal embolism protection system FilterWire was inserted into the proximal part of the basilar artery through the radial artery on the left. The distal embolism protection system RX Accunet was inserted into the distal parts of the left ICA through the left common femoral artery. According to Seldinger, an Acculink stent 7-10 × 30 mm was inserted into the affected area of the A.N. Kazantsev artery, positioned and opened. The postoperative period was uneventful. ACV did not recur. Conducted dual antiplatelet therapy (acetylsalicylic acid 125 mg in the afternoon + clopidogrel 75 mg in the morning). The patient was discharged from the institution on the 10th day after the operation in a satisfactory condition.
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Affiliation(s)
- Anton N Kazantsev
- Kostroma regional clinical hospital named after E.I. Korolev, Kostroma, Russian Federation
| | - Alina S Zharova
- North-Western State Medical University. I.I. Mechnikov, St. Petersburg, Russian Federation
| | - Ekaterina V Sokolova
- North-Western State Medical University. I.I. Mechnikov, St. Petersburg, Russian Federation
| | - Alexander V Korotkikh
- Clinic of Cardiac Surgery of the Amur State Medical Academy of the Ministry of Health of Russia, Blagoveshchensk, Russian Federation
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Kawamura K, Tokugawa J, Watanabe M, Fujita N, Teramoto S, Kimura T, Ito Y, Nakao Y, Yamamoto T. Persistent Primitive Hypoglossal Artery with Ipsilateral Symptomatic Carotid Artery Stenosis and Cerebral Aneurysm. J Stroke Cerebrovasc Dis 2021; 30:106099. [PMID: 34536812 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/29/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE Persistent primitive hypoglossal artery (PPHA) is a rare type of persistent carotid-basilar anastomosis sometimes associated with other vascular lesions. We treated an extremely rare case of PPHA with concomitant ipsilateral symptomatic cervical internal carotid artery (ICA) stenosis and unruptured aneurysm. CASE PRESENTATION A 67-year-old woman visited our institution with acute onset of diplopia. Magnetic resonance imaging revealed multiple acute infarctions in the right anterior and posterior circulations. Digital subtraction angiography demonstrated the right PPHA concomitant with ipsilateral cervical ICA stenosis and an unruptured ICA aneurysm with maximum diameter of 8 mm. The multiple infarctions were considered to result from artery-to-artery embolism due to microthrombi from the ICA plaque passed along the PPHA, so carotid endarterectomy was performed as the first step with preoperative modified Rankin Scale (mRS) grade 1. During the operation, the patient had impaired ICA perfusion due to internal shunt catheter migration into the PPHA followed by acute infarction in the right hemisphere causing mild left hemiparesis. The patient was transferred to the rehabilitation hospital with mRS grade 3. After 3 months of rehabilitation, the patient recovered to mRS grade 1 and clipping surgery for the unruptured right ICA aneurysm was performed as the second step with uneventful postoperative course. CONCLUSION The treatment strategy should be carefully considered depending on the specific blood circulation for such cases of PPHA with unique vasculature.
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Affiliation(s)
- Kaito Kawamura
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan; Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan.
| | - Joji Tokugawa
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan.
| | - Mitsuya Watanabe
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan.
| | - Naohide Fujita
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan; Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan.
| | - Shinichiro Teramoto
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan; Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan.
| | - Takaoki Kimura
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan; Department of Neurosurgery, Shin-Yurigaoka General Hospital, Kawasaki, Kanagawa, Japan.
| | - Yoshitaka Ito
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan; Department of Neurosurgery, Juntendo Tokyo Koto Geriatric Medical Centre, Tokyo, Japan.
| | - Yasuaki Nakao
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan.
| | - Takuji Yamamoto
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan.
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Shchanitsyn IN, Larin IV, Titova II, Sazonova NV, Sumin DI, Ionova TA, Bazhanov SP, Lobkov DV. Surgical treatment in symptomatic stenosis of the carotid artery and persistent primitive hypoglossal artery. Angiol Sosud Khir 2021; 27:159-168. [PMID: 34166357 DOI: 10.33529/angio2021220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Persistent primitive hypoglossal artery is a rare variant of intrauterine anastomosis between the carotid and basilar arteries, which may remain in adults. The presence of this artery in carotid artery atherosclerosis increases the risks for stroke in the carotid and basilar basins. Our clinical case illustrates successful carotid endarterectomy in the presence of an ipsilateral persistent primitive hypoglossal artery under cerebral oximetry control.
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Affiliation(s)
- I N Shchanitsyn
- Neurosurgical Department, Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery, V.I. Razumovsky Saratov State Medical University of the RF Ministry of Public Health, Saratov, Russia
| | - I V Larin
- Department of Roentgenoendovascular Methods of Diagnosis and Treatment, Regional Clinical Hospital, Saratov, Russia
| | - Iu I Titova
- Neurosurgical Department, Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery, V.I. Razumovsky Saratov State Medical University of the RF Ministry of Public Health, Saratov, Russia
| | - N V Sazonova
- Neurosurgical Department, Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery, V.I. Razumovsky Saratov State Medical University of the RF Ministry of Public Health, Saratov, Russia
| | - D Iu Sumin
- Neurosurgical Department, Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery, V.I. Razumovsky Saratov State Medical University of the RF Ministry of Public Health, Saratov, Russia
| | - T A Ionova
- Neurosurgical Department, Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery, V.I. Razumovsky Saratov State Medical University of the RF Ministry of Public Health, Saratov, Russia
| | - S P Bazhanov
- Neurosurgical Department, Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery, V.I. Razumovsky Saratov State Medical University of the RF Ministry of Public Health, Saratov, Russia
| | - D V Lobkov
- Neurosurgical Department, Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery, V.I. Razumovsky Saratov State Medical University of the RF Ministry of Public Health, Saratov, Russia
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Burgard M, Psathas E, Mordasini P, Medlin F, Menth M, Egger B, Oscar Mayer D. Symptomatic internal carotid artery stenosis in the presence of a persistent primary hypoglossal artery. Vascular 2020; 29:543-549. [PMID: 33175663 DOI: 10.1177/1708538120966514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Anatomic variations of the extracranial carotid artery are rare. Persistent primitive hypoglossal artery appears with a reported incidence between 0.03% and 0.2%. We report a case of recurrent transient ischemic attacks originating from proximal internal carotid artery stenosis associated with ipsilateral persistent primitive hypoglossal artery and give a review of the existing literature. METHODS A 78-year-old patient with a medical history of two previous transient ischemic attacks consulted our emergency department with an acute left hemispheric stroke. Intravenous thrombolysis permitted complete resolution of symptoms. Concurrent Computed Tomography (CT) and Magnetic Resonance (MR) angiography revealed an unstable plaque causing 50% stenosis of the left internal carotid artery with a persistent primitive hypoglossal artery dominantly perfusing the posterior circulation, and bilateral hypoplastic vertebral arteries. RESULTS Uneventful carotid artery stenting using a proximal protection device was performed, and the patient was discharged after 12 days. Six months follow-up was uneventful with a patent stent in the internal carotid artery. CONCLUSIONS Treatment of symptomatic carotid artery stenosis in the presence of persistent primitive hypoglossal artery is challenging. Management should be driven by patients' co-morbidities, the anatomical localization of the lesions and local expertise. In the case of a high origin of the persistent primary hypoglossal artery, carotid artery stenting with the use of a proximal cerebral protection device is probably the preferred and simplest approach.
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Affiliation(s)
- Marie Burgard
- Department of Surgery, Vascular Surgery Unit, HFR Fribourg - Cantonal Hospital, Fribourg, Switzerland
| | - Emmanouil Psathas
- Department of Surgery, Vascular Surgery Unit, HFR Fribourg - Cantonal Hospital, Fribourg, Switzerland
| | - Pasquale Mordasini
- University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern Inselspital, Bern, Switzerland
| | - Friedrich Medlin
- Department of Internal Medicine, Neurology Unit, HFR Fribourg - Cantonal Hospital, Fribourg, Switzerland
| | - Markus Menth
- Department of Surgery, Vascular Surgery Unit, HFR Fribourg - Cantonal Hospital, Fribourg, Switzerland
| | - Bernhard Egger
- Department of Surgery, Vascular Surgery Unit, HFR Fribourg - Cantonal Hospital, Fribourg, Switzerland
| | - Dieter Oscar Mayer
- Department of Surgery, Vascular Surgery Unit, HFR Fribourg - Cantonal Hospital, Fribourg, Switzerland
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Rockley M, Ryan SE, Nagpal S. Endarterectomy of carotid artery bifurcation in the setting of a persistent hypoglossal artery and anomalous collateral vascular supply. J Vasc Surg Cases Innov Tech 2020; 6:520-523. [PMID: 33134634 PMCID: PMC7588749 DOI: 10.1016/j.jvscit.2020.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/05/2020] [Indexed: 12/03/2022]
Abstract
Presented is a patient with carotid artery stenosis resulting in crescendo anterior and posterior circulation transient ischemic attacks. Treatment was complicated by a rare persistent hypoglossal artery (HGA) arising from the left internal carotid artery in addition to severe contralateral carotid disease, hypoplastic vertebral arteries, and incomplete circle of Willis. A carotid endarterectomy with shunting was performed, maintaining perfusion of both the proper left internal carotid artery and HGA. This is a rare case of carotid stenosis in the setting of a persistent HGA with contralateral carotid disease and highlights the importance of planning intracranial perfusion before carotid surgery.
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Affiliation(s)
- Mark Rockley
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital-Civic Campus, Ottawa, Ontario, Canada
| | - Stephen E Ryan
- Department of Medical Imaging, University of Ottawa, The Ottawa Hospital-Civic Campus, Ottawa, Ontario, Canada
| | - Sudhir Nagpal
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital-Civic Campus, Ottawa, Ontario, Canada
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Jin X, Sun L, Feng Z, Li X, Zhang H, Meng K, Yu W, Fu C. Persistent Hypoglossal Artery as a Potential Risk Factor for Simultaneous Carotid and Vertebrobasilar Infarcts. Front Neurol 2018; 9:837. [PMID: 30369905 PMCID: PMC6194315 DOI: 10.3389/fneur.2018.00837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/18/2018] [Indexed: 11/13/2022] Open
Abstract
Persistent hypoglossal artery (PHA), a rare embryological carotid–basilar anastomosis, is usually accompanied by hypoplastic vertebral and posterior communicating arteries, and thereby such vascular anomaly serves as the main feeder supplying the vertebrobasilar territory. Although rarely reported, simultaneous anterior and posterior territory infarcts related to PHA and carotid atherosclerosis can occur. To date, as far as we know, only 4 such cases have been previously reported in the literature. Here, we present the case of a 65-year-old female with a PHA and carotid atherosclerotic plaques, who developed acute multiterritorial infarcts involving the left carotid and vertebrobasilar territories. This case highlights that such a persistent anastomosis should be considered when multiple infarcts involving the anterior and posterior territories are encountered, and should be kept in mind when dealing with carotid atherosclerotic lesion.
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Affiliation(s)
- Xingyi Jin
- Department of Neurosurgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Libo Sun
- Department of Neurosurgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zheng Feng
- Department of Pediatrics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Xiaodong Li
- Department of Neurosurgery, Siping Central People's Hospital, Siping, China
| | - Hongyan Zhang
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Ke Meng
- Department of Neurosurgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Weidong Yu
- Department of Neurosurgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Chao Fu
- Department of Neurosurgery, China-Japan Union Hospital of Jilin University, Changchun, China
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Kawabori M, Niiya Y, Iwasaki M, Mabuchi S, Houkin K. Identification of plaque location using intraoperative indocyanine green during carotid endarterectomy for patient with near occlusion. J Neurosurg Sci 2018; 65:397-401. [PMID: 30259719 DOI: 10.23736/s0390-5616.18.04530-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Microscope-integrated near-infrared indocyanine green (ICG) videoangiography (VA) is an effective method of intraoperative blood-flow assessment and identification of plaque location during carotid endarterectomy (CEA). However, the validity of ICG-VA during CEA for patient with near occlusion has not been elucidated. METHODS Thirty-four CEA procedures were performed between June 2009 and December 2017 for patient with near occlusion, which are more than 95% stenosis. The lesions were classified into three groups according to the diameter of distal ICA compared with ipsilateral external carotid artery (ECA), as normal diameter (>100%), moderate diameter reduction (50-100%), severe diameter reduction (<50%). Five mg of ICG was injected intravenously before arteriotomy, and ICG-VA was taken to identify the distal end of the plaque. Depiction of the distal end and its accuracy were retrospectively reviewed. RESULTS There were 18 cases with normal diameter group, 14 cases with moderate diameter reduction group, and 2 cases with severe diameter reduction group. All but one case in the severe diameter reduction group showed apparent distal end signal which were confirmed by arteriotomy afterward. CONCLUSIONS The present study clearly denotes that ICG-VA can visualize the carotid plaque distal end during the CEA, even with the patient with near occlusion. However, it should be noted that there may be a difficulty in visualization of the distal plaque end for patient with severely collapsed distal ICA.
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Affiliation(s)
- Masahito Kawabori
- Department of Neurosurgery, Otaru General Hospital Otaru, Otaru, Japan - .,Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan -
| | - Yoshimasa Niiya
- Department of Neurosurgery, Otaru General Hospital Otaru, Otaru, Japan
| | - Motoyuki Iwasaki
- Department of Neurosurgery, Otaru General Hospital Otaru, Otaru, Japan
| | - Shoji Mabuchi
- Department of Neurosurgery, Otaru General Hospital Otaru, Otaru, Japan
| | - Kiyohiro Houkin
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Varvari I, Bos EM, Dinkelaar W, van Es AC, Can A, Hunfeld M, Du R, Dammers R, Volovici V. Fatal Subarachnoid Hemorrhage from an Aneurysm of a Persistent Primitive Hypoglossal Artery: Case Series and Literature Overview. World Neurosurg 2018; 117:285-291. [PMID: 29940384 DOI: 10.1016/j.wneu.2018.06.119] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/12/2018] [Accepted: 06/14/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Persistent carotid-basilar connections have a prevalence of 0.14%. Recognizing such persistent fetal anastomoses between the carotid and the vertebrobasilar circulation is of great importance because they are reportedly associated with an increased prevalence of intracranial aneurysms. METHODS We report the case of a 15-year-old female patient who presented with a World Federation of Neurosurgical Societies grade 5 subarachnoid hemorrhage from an aneurysm at the junction of a persistent primitive hypoglossal artery and the posterior inferior cerebellar artery origin. Supratentorially, unfortunately, there was no parenchymal blush or cortical venous return. Eventually, a multidisciplinary decision was made to withdraw care. RESULTS Fifty-seven cases were reported in the literature to date of persistent hypoglossal arteries, 16 of which presented with an associated aneurysm, 5 with an arteriovenous malformation, and 6 with a subarachnoid hemorrhage. Our case is the youngest patient reported so far. Hypoplasia or aplasia of the vertebral artery often were encountered (36 and 13 cases, respectively), as well as carotid artery stenosis (15 cases). CONCLUSIONS Although uncommon, it is important to recognize persistent carotid-basilar connections, since they have a considerable hemodynamic impact on the posterior cerebral circulation via the carotid system. A critical reduction in the carotid blood flow will, therefore, have ischemic consequences in the posterior cerebral territories. In addition, such connections might be associated with anomalies of the vessel wall and be predisposed to aneurysm formation. The endovascular neurointerventionalist, as well as the vascular and skull base neurosurgeon, need to be aware of their anatomy and variations.
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Affiliation(s)
- Ioana Varvari
- Department of Adult Mental Health, Tees, Esk and Wear Valleys NHS Trust, United Kingdom
| | - Eelke M Bos
- Department of Neurosurgery, Erasmus MC University Medical Center, Erasmus MC Stroke Center, Rotterdam, The Netherlands
| | - Wouter Dinkelaar
- Department of Radiology, Erasmus MC University Medical Center, Erasmus MC Stroke Center, Rotterdam, The Netherlands
| | - Ad C van Es
- Department of Radiology, Erasmus MC University Medical Center, Erasmus MC Stroke Center, Rotterdam, The Netherlands
| | - Anil Can
- Department of Neurosurgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Maayke Hunfeld
- Department of Pediatric Neurology, Erasmus MC University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Rose Du
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ruben Dammers
- Department of Neurosurgery, Erasmus MC University Medical Center, Erasmus MC Stroke Center, Rotterdam, The Netherlands; Department of Pediatric Neurosurgery, Erasmus MC University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Victor Volovici
- Department of Neurosurgery, Erasmus MC University Medical Center, Erasmus MC Stroke Center, Rotterdam, The Netherlands; Department of Medical Decision Making, Erasmus MC, Rotterdam, The Netherlands.
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Kawano H, Inatomi Y, Hirano T, Yonehara T. Cerebral Infarction in Both Carotid and Vertebrobasilar Territories Associated with a Persistent Primitive Hypoglossal Artery with Severe Dilated Cardiomyopathy. J Stroke Cerebrovasc Dis 2014; 23:176-8. [DOI: 10.1016/j.jstrokecerebrovasdis.2012.07.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 07/24/2012] [Accepted: 07/27/2012] [Indexed: 10/27/2022] Open
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Kawabori M, Yoshimoto T, Ito M, Fujimoto S, Mikami T, Muraki M, Kaneko S, Nakayama N, Kuroda S, Houkin K. Spontaneous echo contrast and thrombus formation at the carotid bifurcation after carotid endarterectomy. Neurol Med Chir (Tokyo) 2013; 52:885-91. [PMID: 23269043 DOI: 10.2176/nmc.52.885] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Spontaneous echo contrast (SEC) consists of numerous microechoes swirling in the cardiovascular lumen and is usually seen during blood stasis in dysfunctional left atrium. However, SEC and consecutive local thrombus formation at the carotid artery early after carotid endarterectomy (CEA) have not been reported. This study retrospectively investigated the clinical importance and therapeutic strategy of postoperative SEC and thrombus formation in 113 consecutive patients who underwent CEA between 2001 and 2009. Ultrasonography was routinely performed preoperatively, intraoperatively, and 1 day and 1 week after the operation. If SEC and/or thrombus was detected at any time after the operation, follow-up ultrasonography was performed at short intervals, once a week for inpatients and once every 1-2 months for outpatients. Eight of the 113 patients (7%) had SEC after the operation from Day 1 to 12 (mean 7.2 days), and 6 of these 8 patients developed local de novo thrombus formation at the site of SEC from Day 6 to 33 (mean 14.7 days). The maximum luminal narrowing by the thrombi were 26-62% (mean 37%). After administering anticoagulant therapy, all thrombi disappeared from Day 13 to 190 (mean 57 days) from CEA. SEC seen after CEA is highly associated with consecutive local thrombus formation. Postoperative geometric blood stasis with the absence of intima may be the causative factor for its development.
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Affiliation(s)
- Masahito Kawabori
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido.
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Yoshikawa G, Kawashima M, Tsutsumi K. Carotid endarterectomy for treatment of tandem carotid stenosis in the presence of the anomalous origin of the occipital artery arising from the cervical internal carotid artery: a case report. J Med Case Rep 2013; 7:254. [PMID: 24199618 PMCID: PMC3835444 DOI: 10.1186/1752-1947-7-254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 09/14/2013] [Indexed: 12/03/2022] Open
Abstract
Introduction Branches from the cervical portion of the internal carotid artery are rare. In most cases, atherosclerotic stenosis is found at the bifurcation of the internal and external carotid arteries. However, when associated with atherosclerotic carotid artery disease, the origin of the rare branches arising from the internal carotid artery can be another site of stenosis. This report describes a rare case of such tandem carotid stenosis treated by carotid endarterectomy and the importance of the possibility of stenosis at the origin of the anomalous branch from the internal carotid artery. Case presentation A 73-year-old Japanese woman presented with transient left hemiparesis and vertigo. Magnetic resonance angiography seemed to indicate two stenotic lesions distal to the right internal carotid artery in addition to the origin of the right internal carotid artery, and angiography indicated tandem stenotic lesions of the internal carotid artery. The patient was successfully treated with right carotid endarterectomy, including the distal stenotic lesion of internal carotid artery, and postoperative angiography indicated that the occipital artery arose from the internal carotid artery. Conclusion It is important to recognize rare cases of the anomalous origin of the occipital artery from the internal carotid artery and the possibility that the origin of such an anomalous occipital artery may be the cause of stenosis.
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Affiliation(s)
- Gakushi Yoshikawa
- Department of Neurosurgery, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira City, Tokyo 187-8510, Japan.
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