Persistent hypoglossal artery: An anomaly leading to false-positive carotid duplex sonography

Duplex ultrasonography is becoming increasingly popular as the sole diagnostic test in the evaluation of carotid artery bifurcation disease. We present a patient with a persistent hypoglossal artery, a rare primitive internal carotid-basilar anastomosis, masquerading as an internal carotid artery stenosis on ultrasound. The operative management of this anomaly is reviewed.