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.
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.
Subject(s)
Humans , Female , Adult , Arteriovenous Anastomosis/surgery , Posterior Cerebral Artery/surgery , Aortic Dissection/surgery , Vertebral Artery/pathology , Magnetic Resonance Angiography , Endovascular Procedures , Headache , Aortic Dissection/diagnostic imagingABSTRACT
Objective To explore the appearance of CT angiography(CTA)and magnetic resonance angiography (MRA)in persis-tent carotid-basilar artery anastomoses,and discuss its clinical significance.Methods 1 7 patients of persistent carotid-basilar artery anastomoses diagnosed by CT and MR angiography were retrospectively reviewed.10 patients were examined by craniocervical CTA, 7 patients were examined by cranial and cervical MRA,and 3 patients were examined by CTA and MRA.Results 10 patients had persistent trigeminal arteries (PTA).Based on Saltzman type:6 cases were Saltzman type Ⅰ,2 cases were Saltzman typeⅡ,and 2 cases were Saltzman type Ⅲ.1 case of 3 persistent hypoglossal arteries(PHA)originated from the right carotid artery,and 2 cases originated from the left external carotid artery.2 cases of 4 proatlantal intersegmental artery(PIA)were right ipsilateral,and 2 cases were left ipsilateral.1 case of PTA and 1 case of PHA associated with an aneurysm.6 cases of PTA,2 cases of PHA and 1 case of PIA complicated with ipsilateral vertebral arteries artopied or hypoplasia of the contralateral vertebral artery.Conclusion CTA and MRA can demonstrate clearly the course of persistent carotid-basilar artery anastomoses and its complicating intracranial coexisting abnormalities.Diagnosis of this anatomic variation may be helpful for providing reliable data to the guidance of surgery and interven-tional treatment.