Case report: Mechanical thrombectomy for acute basilar artery occlusion via persistent hypoglossal artery

Xin Zhang; Jiaxiong Wang; Zhipeng Cao; Yingtao Liu; Yi Dong; Xin Cheng; Chao Gao; Yuxiang Gu

doi:10.3389/fneur.2023.1200539

Case report: Mechanical thrombectomy for acute basilar artery occlusion via persistent hypoglossal artery

Front Neurol. 2023 Jul 27:14:1200539. doi: 10.3389/fneur.2023.1200539. eCollection 2023.

Authors

Xin Zhang^#^{1

2

3

4

5}, Jiaxiong Wang^#^{1

6}, Zhipeng Cao^{2

7}, Yingtao Liu^{2

8}, Yi Dong^{2

7}, Xin Cheng^{2

7}, Chao Gao^{1

2

3

4

5}, Yuxiang Gu^{1

2

3

4

5}

Affiliations

¹ Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
² National Center for Neurological Disorders, Shanghai, China.
³ Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.
⁴ Neurosurgical Institute of Fudan University, Shanghai, China.
⁵ Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China.
⁶ Department of Neurosurgery, South Yunnan Central Hospital of Yunnan Province, Mengzi, Yunnan, China.
⁷ Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.
⁸ Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China.

^# Contributed equally.

Abstract

Persistent hypoglossal artery (PHA) is a rare carotid-vertebrobasilar anastomosis in adults. Here, we report a case of mechanical thrombectomy for acute basilar artery occlusion via the PHA. A 44-year-old man was admitted to our stroke unit with an unstable gait and aphasia for 2 h. The baseline National Institutes of Health Stroke Scale (NIHSS) score was 4, but the clinical symptoms continued to worsen. Computed tomography angiography showed the absence of the basilar artery and an abnormal anastomosis between the anterior and posterior circulation. Clinical symptoms continued to worsen, and endovascular treatment was scheduled. PHA was demonstrated and basilar artery occlusion was confirmed using digital subtraction angiography. Mechanical thrombectomy with a stent retriever and aspiration was performed via the PHA, and modified thrombolysis in cerebral infarction level 3 was achieved. The patient underwent intravenous antiplatelet therapy after the operation, and follow-up neuroimaging revealed multiple small infarcts in the cerebellum and medulla oblongata. The patient was discharged after 10 days for further rehabilitation, with an NIHSS score of 25. At 10 months follow-up, the NIHSS score decreased to 18. Recognition of this rare variation is particularly important for interventional strategy determination and rapid recanalization of basilar artery occlusion.

Keywords: acute ischemic stroke; basilar artery occlusion; case report; persistent hypoglossal artery; thrombectomy.

Publication types

Case Reports

Grants and funding

This study was supported by the National Natural Science Foundation of China (Grant Number 82171313) and the Shanghai Hospital Development Center (Grant Number SHDC2022CRD032).