Persistent Hypoglossal Artery as a Potential Risk Factor for Simultaneous Carotid and Vertebrobasilar Infarcts

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.

Endarterectomy of carotid artery bifurcation in the setting of a persistent hypoglossal artery and anomalous collateral vascular supply

“…Persistent HGAs are often accompanied by hypoplastic or atretic vertebral and posterior communicating arteries. 4 , 5 , 6 In the setting of a persistent HGA, at least one vertebral or posterior communicating artery is hypoplastic or atretic in 86% and 94%, respectively, and both are hypoplastic or atretic in 28% and 78%, respectively. 5 These findings have been noted by previous authors as complicating carotid endarterectomy in the context of a persistent HGA.…”

“… 9 Our patient presented with both anterior and posterior circulation symptoms, which has been reported by five previous authors. 4 , 10 , 11 , 12 , 13 …”

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

“…1 PHA is associated with intracranial aneurysms, atherosclerotic changes, and subsequent posterior circulation ischemia. [3][4][5] We hereby present a case of dissecting posterior cerebral artery aneurysm associated with PHA. Endovascular coiling with parent vessel occlusion (PVO) was performed for the aneurysm.…”

“…1,2 Failure of regression of these channels will lead to formation of persistent carotid-basilar anastomosis, the most common of which is the persistent trigeminal artery. 3 Persistent hypoglossal artery (PHA) is the second most common persistent carotid-basilar anastomosis with a reported incidence of 0.1-.02%. 1 PHA is associated with intracranial aneurysms, atherosclerotic changes, and subsequent posterior circulation ischemia.…”

Benign paroxysmal positional vertigo in a patient with persistent hypoglossal artery and bilateral madelung deformity

“…Persistent hypoglossal artery (PHA) is a rare congenital carotid-basilar anastomosis ( Avcu et al, 2009 , Coulier, 2018 , MR, 2016 , Fantini et al, 1994 , Jin et al, 2018 ). While persistent trigeminal artery (PTA) is the most common carotid-vertebrobasilar anastomoses with prevalence estimated to be 0.1–0.2%, PHA is the second most common with reported prevalence of 0.03–0.09% PHA has been associated with various cardiovascular events, including embolic stroke ( Avcu et al, 2009 , Jin et al, 2018 ).…”