Oğuz YILMAZ, Serdar SOLAK, Furuzan NUMAN, Murat CANTAŞDEMİR, Fatih GÜLŞEN, Bingür SÖNMEZ

A successful treatment with carotid arterial stenting for symptomatic severe internal carotid artery stenosis with ipsilateral persistent primitive hypoglossal artery and aplasia of the A1 segment of anterior cerebral artery: a case report

Vertigo ve senkop nöbetleri geçiren ve aynı tarafta servikal internal karotis arter (İKA) darlığı olan 85 yaşında bir erkek persistan primitif hipoglossal arter (PPHA) olgusu sunuldu. Embolik koruma cihazları olmaksızın karotis arter stentleme (KAS) işlemi yapıldı. Hastanın ameliyat sonrası klinik seyri iyiydi. Ameliyat sonrası manyetik rezonans görüntülemede iskemik komplikasyon izlenmedi. Ameliyatın beşinci gününde, nörolojik semptomu olmayan hasta taburcu edildi. Bilgimiz dahilinde bu olgu, literatürdeki KAS ile tedavi edilen ve ipsilateral karotis-baziler anastomozlu ikinci İKA darlığı olgusudur. Persistan karotis-vertebrobaziler anastomozları çok nadir görülmekle birlikte, nörolojik defisitlere ve hatta ölüme yol açan iyatrojenik hasarı önlemek için iyatrojenik girişimsel radyologlar, vasküler ve kardiyovasküler cerrahlar ve nöroşirürji uzmanlarının bu nadir varyasyonun varlığını göz önünde bulundurması gereklidir. Nörovasküler patolojilerin tedavisinde tedavi seçeneklerini etkileyebilen veya işlem tekniğini değiştirebilen varyasyon ve anomaliler de göz önünde bulundurulmalıdır.

İpsilateral persistan primitif hipoglossal arter ve ön serebral arterin A1 segmentinde aplazi ile birliktelik gösteren ciddi internal karotis arter darlığının karotis arteriyel stentleme ile başarılı tedavisi: Olgu sunumu

We report a 85-year-old male case with persistent primitive hypoglossal artery (PPHA) who experienced vertigo and syncope attacks and had cervical internal carotid artery (ICA) stenosis at the same side. A carotid artery stenting (CAS) procedure was performed without embolic protection devices. The patient’s postoperative clinical course was good. Postoperative magnetic resonance imaging showed no ischemic complications. On fifth day of surgery, the patient was discharged with no neurological symptoms. We report, to the best of our knowledge, the second case of ICA stenosis with ipsilateral carotid-basilar anastomosis treated with CAS presented in the literature. Although persistent carotidvertebrobasilar anastomoses are very rare; awareness of the presence of this rare variation is essential for interventional radiologists, vascular and cardiovascular surgeons and neurosurgeons to avoid iatrogenic injury causing neurologic deficits, and even death. For the treatment of neurovascular pathologies, variations and anomalies which can affect treatment options or modify the procedural technique should be also considered.

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