Sanada Takahiro, Shirai Wakako, Yamamoto Shota, Kinoshita Manabu, Tokumitsu Naoki
Department of Neurosurgery, Nayoro City General Hospital, Nayoro, Japan.
Department of Neurosurgery, Asahikawa Medical University, Asahikawa, Japan.
J Surg Case Rep. 2021 Aug 31;2021(8):rjab362. doi: 10.1093/jscr/rjab362. eCollection 2021 Aug.
Only several cases of internal carotid artery (ICA) stenosis involving the persistent primitive hypoglossal artery (PPHA) have been treated with carotid endarterectomy (CEA) because of its extreme rarity. CEA was performed for an 87-year-old female with severe stenosis of the right ICA-PPHA bifurcation requiring shunting from CCA to both PPHA and ICA. We initially attempted to insert two intraluminal balloon shunts into the CCA, as previously reported. However, we found this procedure technically impossible to achieve. An improvised three-way junction tube was inserted distally into PPHA and ICA and proximally into CCA, securing blood flow during CEA. Unfortunately, the patient suffered post-operative ischemic brain lesions due to the prolonged ischemic time during our initial unsuccessful shunt attempt. A three-way junction shunting tube could be an effective shunt technique during an anatomically complicated CEA.
由于涉及永存原始舌下动脉（PPHA）的颈内动脉（ICA）狭窄极为罕见，仅有几例此类病例接受了颈动脉内膜切除术（CEA）治疗。一名87岁女性因右侧ICA-PPHA分叉处严重狭窄，需要从颈总动脉（CCA）分流至PPHA和ICA，接受了CEA手术。正如之前报道的那样，我们最初试图在CCA中插入两根腔内球囊分流管。然而，我们发现该操作在技术上无法实现。于是，一根临时制作的三通连接管被远端插入PPHA和ICA，近端插入CCA，在CEA手术期间确保了血流。不幸的是，由于我们最初分流尝试失败导致缺血时间延长，患者术后出现了缺血性脑损伤。在解剖结构复杂的CEA手术中，三通连接分流管可能是一种有效的分流技术。
