Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.200142
Jornal Vascular Brasileiro
Case Report

Endovascular management of dissecting posterior cerebral artery aneurysm associated with persistent hypoglossal artery: A case report

Tratamento endovascular do aneurisma dissecante da artéria cerebral posterior associado à artéria hipoglossa persistente: relato de caso

Vivek Murumkar; Sameer Peer; Jitender Saini; Hanumanthapura Ramalingaiah Arvinda

Downloads: 0
Views: 62

Abstract

Abstract: Persistent embryological connections between the anterior and posterior circulations are rare entities. Persistent hypoglossal artery is the second most common persistent carotid-basilar anastomosis. As it is often associated with hypoplasia of vertebral arteries, it poses a challenge during endovascular interventions. We present a case of a 32-year-old woman who presented with occipital headache of four weeks’ duration. Magnetic Resonance Angiography showed hypoplastic vertebral arteries with a persistent hypoglossal artery arising from the cervical segment of the left internal carotid artery and supplying the entire posterior circulation, associated with a dissecting aneurysm of the right posterior cerebral artery. Endovascular parent vessel occlusion was performed for the dissecting posterior cerebral artery aneurysm by navigating the guide catheter, microwire, and microcatheter through the persistent hypoglossal artery because the vertebral arteries were hypoplastic. Post-intervention, the patient did not develop any neurological deficit and was discharged in a stable condition.

Keywords

persistent hypoglossal artery, carotid-basilar anastomosis, dissecting aneurysm

Resumo

Resumo: Conexões embriológicas persistentes entre as circulações anterior e posterior são entidades raras. A artéria hipoglossa persistente é a segunda anastomose carotídeo-basilar persistente mais comum. Como está frequentemente associada à hipoplasia das artérias vertebrais, apresenta um desafio durante as intervenções endovasculares. Apresentamos o caso de uma mulher de 32 anos que apresentou cefaleia occipital com duração de quatro semanas. A angiografia por ressonância magnética mostrou artérias vertebrais hipoplásicas com artéria hipoglossa persistente surgindo do segmento cervical da artéria carótida interna esquerda e suprindo toda a circulação posterior com um aneurisma dissecante da artéria cerebral posterior direita. A oclusão endovascular do vaso parental foi realizada para o aneurisma da dissecção da artéria cerebral posterior pela passagem de cateter guia, microfio e microcateter pela artéria hipoglossa persistente, pois as artérias vertebrais eram hipoplásicas. Após a intervenção, a paciente não apresentou déficit neurológico e recebeu alta em uma condição estável.
 

Palavras-chave

artéria hipoglossa persistente, anastomose carotídeo-basilar, aneurisma dissecante

References

1 Namba K. Carotid-vertebrobasilar anastomoses with reference to their segmental property. Neurol Med Chir (Tokyo). 2017;57(6):267-77. http://dx.doi.org/10.2176/nmc.ra.2017-0050. PMid:28458386.

2 Blain JG, Logothetis J. The persistent hypoglossal artery. J Neurol Neurosurg Psychiatry. 1966;29(4):346-9. http://dx.doi.org/10.1136/jnnp.29.4.346. PMid:5969092.

3 Jin X, Sun L, Feng Z, et al. Persistent hypoglossal artery as a potential risk factor for simultaneous carotid and vertebrobasilar infarcts. Front Neurol. 2018;9:1-5. http://dx.doi.org/10.3389/fneur.2018.00837. PMid:30369905.

4 De Blasi R, Medicamento N, Chiumarulo L, et al. A case of aneurysm on a persistent hypoglossal artery treated by endovascular coiling. Interv Neuroradiol. 2009;15(2):175-8. http://dx.doi.org/10.1177/159101990901500206. PMid:20465895.

5 Varvari I, Bos EM, Dinkelaar W, et al. Fatal Subarachnoid Hemorrhage from an Aneurysm of a Persistent Primitive Hypoglossal Artery: Case Series and Literature Overview. World Neurosurg. 2018;117:285-91. http://dx.doi.org/10.1016/j.wneu.2018.06.119. PMid:29940384.

6 Luh GV, Robert C, Dean BL. The Persistent Anastomoses. AJR Am J Roentgenol. 1999;172(5):1427-32. http://dx.doi.org/10.2214/ajr.172.5.10227532. PMid:10227532.

7 Vlychou M, Georganas M, Spanomichos G, Kanavaros P, Artinopoulos C, Zavras GM. Angiographic findings and clinical implications of persistent primitive hypoglossal artery. BMC Med Imaging. 2003;3(1):2. http://dx.doi.org/10.1186/1471-2342-3-2. PMid:12877754.

8 Bruetman ME, Fields WS. Persistent hypoglossal artery. Arteria hypoglossica primitiva. Arch Neurol. 1963;8(4):369-72. http://dx.doi.org/10.1001/archneur.1963.00460040039002. PMid:14016188.

9 Madden NJ, Calligaro KD, Dougherty MJ, Maloni K, Troutman DA. Persistent Hypoglossal Artery: Challenges Associated With Carotid Revascularization. Vasc Endovascular Surg. 2019;53(7):589-92. http://dx.doi.org/10.1177/1538574419859102. PMid:31248350.

10 Wagner AL. Isolated stenosis of a persistent hypoglossal artery visualized at 3D CT angiography. AJNR Am J Neuroradiol. 2001;22(8):1613-4. PMid:11559517.

11 Lv X, Li Y, Jiang C, Yang X, Wu Z. Parent vessel occlusion for P2 dissecting aneurysms of the posterior cerebral artery. Surg Neurol. 2009;71(3):319-25. http://dx.doi.org/10.1016/j.surneu.2008.01.047. PMid:18440610.

12 Qian Z, Feng X, Kang H, et al. Dissecting aneurysms of the distal segment of the posterior cerebral artery: Clinical presentation and endovascular management. Chinese Neurosurg J. 2017;3(1):1-9. http://dx.doi.org/10.1186/s41016-016-0066-z.

13 Taqi MA, Lazzaro MA, Pandya DJ, Badruddin A, Zaidat OO. Dissecting aneurysms of posterior cerebral artery: Clinical presentation, angiographic findings, treatment, and outcome. Front Neurol. 2011;2(38):1-6. http://dx.doi.org/10.3389/fneur.2011.00038. PMid:21734905.

14 Goehre F, Jahromi BR, Lehecka M, et al. Posterior Cerebral Artery Aneurysms: Treatment and Outcome Analysis in 121 Patients. World Neurosurg. 2016;92:521-32. http://dx.doi.org/10.1016/j.wneu.2016.03.063. PMid:27044373.

15 Huang Q, Liu J, Zhao R, et al. The safety and efficacy of stenting in the treatment of complex posterior cerebral artery aneurysms: A seven-case report and literature review. Clin Neuroradiol. 2013;23(3):175-87. http://dx.doi.org/10.1007/s00062-013-0219-9. PMid:23760259.
 


Submitted date:
08/15/2020

Accepted date:
11/18/2020

6103f296a953953d415a5492 jvb Articles
Links & Downloads

J Vasc Bras

Share this page
Page Sections