OBJECTIVE AND IMPORTANCE: A persistent hypoglossal artery, one of the embryonic carotid-basilar anastomoses that can fail to regress in the embryo and can be observed past birth, is one of the only congenital anatomic variations of the internal carotid artery (ICA) that can complicate the performance of carotid endarterectomy. When associated with atherosclerotic carotid artery disease, the recognition and intraoperative management of a persistent hypoglossal artery is important. CLINICAL PRESENTATION: A 72-year-old man presented with a symptom of transient right hemisphere ischemia, and although ultrasonography indicated a right ICA stenosis (and no other abnormality), angiography also demonstrated that the atherosclerotic plaque extended into the origin of a large right persistent hypoglossal artery arising 1.5 cm from the origin of the ICA. In this patient, the persistent hypoglossal artery was the only arterial supply to the basilar artery. INTERVENTION: The patient underwent a right ICA endarterectomy, and intraoperative angiography was necessary to ensure that the persistent hypoglossal artery was the vessel shunted during the arterial repair. CONCLUSION: Recognition of the primitive carotid-basilar anastomoses is important to surgeons who perform carotid endarterectomy and is not possible with ultrasonography alone. Intraoperative angiography enables the surgeon to accurately catheterize a persistent hypoglossal artery with a carotid shunt.
OBJECTIVE AND IMPORTANCE: A persistent hypoglossal artery, one of the embryonic carotid-basilar anastomoses that can fail to regress in the embryo and can be observed past birth, is one of the only congenital anatomic variations of the internal carotid artery (ICA) that can complicate the performance of carotid endarterectomy. When associated with atherosclerotic carotid artery disease, the recognition and intraoperative management of a persistent hypoglossal artery is important. CLINICAL PRESENTATION: A 72-year-old man presented with a symptom of transient right hemisphere ischemia, and although ultrasonography indicated a right ICA stenosis (and no other abnormality), angiography also demonstrated that the atherosclerotic plaque extended into the origin of a large right persistent hypoglossal artery arising 1.5 cm from the origin of the ICA. In this patient, the persistent hypoglossal artery was the only arterial supply to the basilar artery. INTERVENTION: The patient underwent a right ICA endarterectomy, and intraoperative angiography was necessary to ensure that the persistent hypoglossal artery was the vessel shunted during the arterial repair. CONCLUSION: Recognition of the primitive carotid-basilar anastomoses is important to surgeons who perform carotid endarterectomy and is not possible with ultrasonography alone. Intraoperative angiography enables the surgeon to accurately catheterize a persistent hypoglossal artery with a carotid shunt.