PERSISTENT HYPOGLOSSAL ARTERY - DIAGNOSTIC AND THERAPEUTIC CONSIDERATIONS CONCERNING CAROTID THROMBOENDARTERECTOMY

Fetal anastomotic connections between the developing internal carotid and basilar arterial systems are via the three presegmental arteries: the otic artery, the hypoglossal artery, and the trigeminal artery. Af ter formation of the posterior communicating artery from the caudal br anch of the internal carotid artery, the presegmental arteries are gen erally obliterated. Rarely, however, these primitive carotid-basilar a nastomoses will persist into adult life, and may be detected as incide ntal findings at the time of cerebral angiography during evaluation of the patient with suspected cerebrovascular disease. In addition, pers istence of such anastomoses may result in the coexistence of anterior and posterior circulation symptoms, precipitating diagnostic confusion . Two patients with symptoms and persistent hypoglossal artery undergo ing carotid thromboendarterectomy are discussed, with emphasis on clin ical presentation, diagnostic criteria and intraoperative management.