Carotid endarterectomy in the setting of persistent hypoglossal artery
Persistent hypoglossal artery (PHA) is a rare, anatomical variant in which the posterior cerebral circulation is primarily supplied by a branch of the carotid artery, rather than the vertebral arteries. This case report discusses carotid endarterectomy performed on a man, 67 years of age, with high-...
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| Format: | Article |
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Elsevier
2025-02-01
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| Series: | Journal of Vascular Surgery Cases and Innovative Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468428724002326 |
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| author | Samuel D. Leonard, MD Lili Sadri, MD Hung Nguyen, MD Naveed Saqib, MD Marvin Heck, MD Gordon Martin, MD |
| author_facet | Samuel D. Leonard, MD Lili Sadri, MD Hung Nguyen, MD Naveed Saqib, MD Marvin Heck, MD Gordon Martin, MD |
| author_sort | Samuel D. Leonard, MD |
| collection | DOAJ |
| description | Persistent hypoglossal artery (PHA) is a rare, anatomical variant in which the posterior cerebral circulation is primarily supplied by a branch of the carotid artery, rather than the vertebral arteries. This case report discusses carotid endarterectomy performed on a man, 67 years of age, with high-grade, asymptomatic carotid artery stenosis and ipsilateral PHA. Preoperative computed tomography angiography identified the PHA arising from the internal carotid artery, compensating for atretic bilateral vertebral arteries and providing primary perfusion to anterior spinal artery. A carotid endarterectomy with a bovine pericardial patch was executed under general anesthesia, incorporating preemptive shunting of the PHA and intraoperative electroencephalogram monitoring. The operation proceeded without complications, maintaining normal electroencephalogram readings, and the patient exhibited no focal neurological deficits postoperatively, although transient dysphagia was noted. Follow-up imaging at 4 months confirmed the patency of the internal carotid artery and PHA. This case underscores the necessity for meticulous surgical planning and monitoring in the presence of rare vascular anomalies to ensure successful outcomes. The key takeaway is that comprehensive, preoperative imaging, individualized surgical strategies, and vigilant postoperative monitoring are critical for managing rare vascular anomalies, such as PHA. |
| format | Article |
| id | doaj-art-81f5ce36f622485a84d2c5ce53275cb5 |
| institution | Kabale University |
| issn | 2468-4287 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Vascular Surgery Cases and Innovative Techniques |
| spelling | doaj-art-81f5ce36f622485a84d2c5ce53275cb52025-01-20T04:17:39ZengElsevierJournal of Vascular Surgery Cases and Innovative Techniques2468-42872025-02-01111101648Carotid endarterectomy in the setting of persistent hypoglossal arterySamuel D. Leonard, MD0Lili Sadri, MD1Hung Nguyen, MD2Naveed Saqib, MD3Marvin Heck, MD4Gordon Martin, MD5Department of Surgery and Perioperative Care, University of Texas at Austin, Dell Medical School, Austin, TXDepartment of Surgery and Perioperative Care, University of Texas at Austin, Dell Medical School, Austin, TXDivision of Vascular Surgery, Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth Houston, Houston, TXDivision of Vascular Surgery, Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth Houston, Houston, TXDepartment of Surgery, University of Texas, Health Science Center at Tyler, Tyler, TXDivision of Vascular Surgery, Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth Houston, Houston, TX; Correspondence: Gordon Martin, MD, Assistant Professor of Vascular Surgery, Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth Houston, Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, 1631 North Loop West, Ste #610, Houston, TX 77008Persistent hypoglossal artery (PHA) is a rare, anatomical variant in which the posterior cerebral circulation is primarily supplied by a branch of the carotid artery, rather than the vertebral arteries. This case report discusses carotid endarterectomy performed on a man, 67 years of age, with high-grade, asymptomatic carotid artery stenosis and ipsilateral PHA. Preoperative computed tomography angiography identified the PHA arising from the internal carotid artery, compensating for atretic bilateral vertebral arteries and providing primary perfusion to anterior spinal artery. A carotid endarterectomy with a bovine pericardial patch was executed under general anesthesia, incorporating preemptive shunting of the PHA and intraoperative electroencephalogram monitoring. The operation proceeded without complications, maintaining normal electroencephalogram readings, and the patient exhibited no focal neurological deficits postoperatively, although transient dysphagia was noted. Follow-up imaging at 4 months confirmed the patency of the internal carotid artery and PHA. This case underscores the necessity for meticulous surgical planning and monitoring in the presence of rare vascular anomalies to ensure successful outcomes. The key takeaway is that comprehensive, preoperative imaging, individualized surgical strategies, and vigilant postoperative monitoring are critical for managing rare vascular anomalies, such as PHA.http://www.sciencedirect.com/science/article/pii/S2468428724002326TCARCEATranscarotid artery revascularizationPersistent hypoglossal arteryPHAStroke |
| spellingShingle | Samuel D. Leonard, MD Lili Sadri, MD Hung Nguyen, MD Naveed Saqib, MD Marvin Heck, MD Gordon Martin, MD Carotid endarterectomy in the setting of persistent hypoglossal artery Journal of Vascular Surgery Cases and Innovative Techniques TCAR CEA Transcarotid artery revascularization Persistent hypoglossal artery PHA Stroke |
| title | Carotid endarterectomy in the setting of persistent hypoglossal artery |
| title_full | Carotid endarterectomy in the setting of persistent hypoglossal artery |
| title_fullStr | Carotid endarterectomy in the setting of persistent hypoglossal artery |
| title_full_unstemmed | Carotid endarterectomy in the setting of persistent hypoglossal artery |
| title_short | Carotid endarterectomy in the setting of persistent hypoglossal artery |
| title_sort | carotid endarterectomy in the setting of persistent hypoglossal artery |
| topic | TCAR CEA Transcarotid artery revascularization Persistent hypoglossal artery PHA Stroke |
| url | http://www.sciencedirect.com/science/article/pii/S2468428724002326 |
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