Surgical revascularization in the presence of a preserved primitive carotid-basilar communication

Anomalous arteries that connect the anterior and posterior cranial arterial systems are unusual variants that can severely alter normal patterns of cerebral blood flow. Persistent trigeminal, hypoglossal, otic, and proatlantal arteries have been described. This report illustrates the technical aspects of carotid endarterectomy with an ipsilateral preserved primitive carotid-basilar communication. Identification of the internal carotid and hypoglossal arteries, maintenance of cerebral perfusion, arteriotomy closure, preoperative imaging, the use of shunts, and reconstruction strategy are discussed. Preoperative angiography and detailed, individualized surgical strategy should be used to ensure a successful endarterectomy in patients with preserved primitive carotid-basilar communications.