When Carotid Artery Stenosis Cause Posterior Fossa Infarct. An Unusual Case of Persistent Hypoglossal Artery.

IF 0.7 4区医学 Q4 PERIPHERAL VASCULAR DISEASE

Vascular and Endovascular Surgery Pub Date : 2023-11-01 Epub Date: 2023-06-09 DOI:10.1177/15385744231183474

Maysam Shehab, Rotem Sivan Hoffmann, Claudia Granbichler, Menashe Haddad, Adi Bachar

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Abstract

Background: The primitive anastomosis between the carotid artery and the vertebrobasilar arteries usually regress, in rare cases they persist beyond fetal development and form vascular anomalies such as primitive persistent hypoglossal artery(PPHA), with prevalence of 0.02-0.1% in the general population.

Case report: A 77-year-old female presented with aphasia, weakness of both legs and arms. Computed Tomography Angiography (CTA) revealed subacute infarct in right pones, severe stenosis of the right internal carotid artery(RICA) and ipsilateral PPHA. We performed Right carotid artery stenting (CAS) using a distal filter into the PPHA to protect the posterior circulation, with good result.

Discussion: The posterior circulation was utterly dependent on the RICA, therefore, despite the general notion that carotid stenosis is usually associated with anterior circulation infarcts, in cases having vascular anomalies it may cause a posterior stroke. Carotid artery stenting offer a safe and simple solution, however the use of EPD requires special considerations regarding decision on the suitable protection technique and placement.

Conclusion: Neurological symptoms in the presence of carotid artery stenosis and PPHA can manifest as ischemia of the anterior and/or the posterior circulation. In our opinion, CAS gives a simple and safe treatment solution.

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当颈动脉狭窄导致后Fossa梗塞时。一例罕见的持续性舌下动脉。

背景：颈动脉和椎基底动脉之间的原始吻合通常会退化，在极少数情况下，它们会持续到胎儿发育之后，并形成血管异常，如原始持续性舌下动脉（PPHA），在普通人群中的患病率为0.02-0.1%。病例报告：一位77岁的女性，表现为失语症，双腿和双臂无力。计算机断层扫描血管造影（CTA）显示右pones亚急性梗死、右颈内动脉（RICA）严重狭窄和同侧PPHA。我们在PPHA中使用远端过滤器进行了右颈动脉支架植入术（CAS），以保护后循环，结果良好。讨论：后循环完全依赖于RICA，因此，尽管颈动脉狭窄通常与前循环梗死有关，但在血管异常的情况下，它可能会导致后卒中。颈动脉支架置入术提供了一种安全而简单的解决方案，但EPD的使用需要在决定合适的保护技术和放置时进行特殊考虑。结论：颈动脉狭窄和PPHA的神经系统症状可表现为前循环和/或后循环缺血。在我们看来，CAS提供了一种简单而安全的治疗方案。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Vascular and Endovascular Surgery SURGERY-PERIPHERAL VASCULAR DISEASE

CiteScore

1.70

自引率

11.10%

发文量

132

审稿时长

4-8 weeks

期刊介绍： Vascular and Endovascular Surgery (VES) is a peer-reviewed journal that publishes information to guide vascular specialists in endovascular, surgical, and medical treatment of vascular disease. VES contains original scientific articles on vascular intervention, including new endovascular therapies for peripheral artery, aneurysm, carotid, and venous conditions. This journal is a member of the Committee on Publication Ethics (COPE).