Strategy of cerebral endovascular treatment for cervical internal carotid artery stenosis with a persistent primitive hypoglossal artery

Shinichiro Yoshida; Kaisei Kamatani; Kousuke Takigawa; Noriaki Tashiro; Yoshiya Hashiguchi; Masahiro Yasaka; Hiroshi Aikawa; Yoshinori Go; Kiyoshi Kazekawa

doi:10.25259/SNI_567_2023

Strategy of cerebral endovascular treatment for cervical internal carotid artery stenosis with a persistent primitive hypoglossal artery

Surg Neurol Int. 2023 Sep 1:14:308. doi: 10.25259/SNI_567_2023. eCollection 2023.

Authors

Shinichiro Yoshida¹, Kaisei Kamatani¹, Kousuke Takigawa¹, Noriaki Tashiro², Yoshiya Hashiguchi², Masahiro Yasaka², Hiroshi Aikawa¹, Yoshinori Go¹, Kiyoshi Kazekawa¹

Affiliations

¹ Department of Neurosurgery, Fukuoka Neurosurgical Hospital, Fukuoka, Japan.
² Department of Cerebrovascular Medicine, Fukuoka Neurosurgical Hospital, Fukuoka, Japan.

Abstract

Background: Persistent primitive hypoglossal artery (PPHA) is a rare residual arterial anastomosis. We placed a CASPER stent using Spider FX as an embolic protection device (EPD) in a patient with internal carotid artery (ICA) stenosis and PPHA. There are no reports of carotid artery stenting (CAS) using a CASPER stent for ICA stenosis with PPHA. We report the EPD strategy used in this case and the usefulness and precautions of CASPER stent insertion for cervical ICA stenosis in association with PPHA.

Methods: A 9Fr sheath was placed in the right femoral artery and a 9Fr Branchor balloon guide catheter was guided to the common carotid artery. A Spider FX was placed proximal to the bifurcation of the ICA and the PPHA. A 10 mm × 20 mm CASPER stent was deployed at the site of the stricture with no postoperative ischemic complications.

Results: There was no intra-stent occlusion, stenosis, or plaque protrusion immediately after surgery, and no postoperative ischemic complications were observed.

Conclusion: CASPER stent deployment with the Spider FX in the ICA and PPHA bifurcation can be considered to be an effective treatment method for ICA stenosis associated with PPHA. However, care should be taken in selecting the appropriate EPDs and stents depending on the location of the stenosis and bifurcation of the PPHA.

Keywords: CASPER; carotid artery stenting; carotid stenting; persistent primitive hypoglossal artery.