CAROTID ENDARTERECTOMY IN THE PRESENCE OF A PERSISTENT HYPOGLOSSAL ARTERY - CASE-REPORT

OBJECTIVE AND IMPORTANCE: A persistent hypoglossal artery, one of the embryonic carotid-basilar anastamoses that can fail to regress in the embryo and can be observed past birth, is one of the only congenital a natomic variations of the internal carotid artery (ICA) that can compl icate the performance of carotid endarterectomy. When associated with atherosclerotic carotid artery disease, the recognition and intraopera tive management of a persistent hypoglossal artery is important. CLINI CAL PRESENTATION: A 72-year-old man presented with a symptom of transi ent right hemisphere ischemia, and although ultrasonography indicated a right ICA stenosis (and no other abnormality), angiography also demo nstrated that the atherosclerotic plaque extended into the origin of a large right persistent hypoglossal artery arising 1.5 cm from the ori gin of the ICA. In this patient, the persistent hypoglossal artery was the only arterial supply to the basilar artery. INTERVENTION: The pat ient underwent a right ICA endarterectomy, and intraoperative angiogra phy was necessary to ensure that the persistent hypoglossal artery was the vessel shunted during the arterial repair. CONCLUSION: Recognitio n of the primitive carotid-basilar anastamoses is important to surgeon s who perform carotid endarterectomy and is not possible with ultrason ography alone. Intraoperative angiography enables the surgeon to accur ately catheterize a persistent hypoglossal artery with a carotid shunt .