Department of Surgery, Vascular Surgery Unit, HFR Fribourg - Cantonal Hospital, Fribourg, Switzerland.
University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern Inselspital, Bern, Switzerland.
Vascular. 2021 Aug;29(4):543-549. doi: 10.1177/1708538120966514. Epub 2020 Nov 11.
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.
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.
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.
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.
颅外颈动脉解剖变异较为罕见。永存舌下动脉以 0.03%至 0.2%的报告发生率出现。我们报告了一例起源于近端颈内动脉狭窄的复发性短暂性脑缺血发作，该患者伴有同侧永存舌下动脉，并对现有文献进行了回顾。
一位 78 岁的患者，有两次短暂性脑缺血发作的病史，因急性左侧半球性中风到我们的急诊就诊。静脉溶栓治疗使症状完全缓解。同时进行的计算机断层扫描（CT）和磁共振（MR）血管造影显示不稳定斑块导致左侧颈内动脉狭窄 50%，永存舌下动脉主要为后循环供血，双侧椎动脉发育不良。
使用近端保护装置进行了顺利的颈动脉支架置入术，患者在 12 天后出院。6 个月的随访无并发症，颈内动脉内的支架通畅。
在存在永存舌下动脉的情况下，治疗有症状的颈动脉狭窄具有挑战性。管理应根据患者的合并症、病变的解剖定位和当地的专业知识来决定。对于永存舌下动脉起源较高的情况，使用近端脑保护装置的颈动脉支架置入术可能是首选且最简单的方法。
