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Basilar stroke from a persistent hypoglossal artery.

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Successful endovascular thrombectomy for basilar artery occlusion is possible, even with rare persistent fetal cerebrovascular anatomy. Recognizing unusual anatomy pre-procedure is critical for effective treatment of stroke.

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Area of Science:

  • Neurology
  • Vascular Neurology
  • Interventional Neurology

Background:

  • Basilar artery occlusion (BAO) is a severe stroke subtype often requiring endovascular thrombectomy.
  • Persistent fetal cerebrovascular anatomy, though rare, can complicate stroke treatment and diagnosis.
  • Carotid atherosclerotic disease can present atypically due to variations in cerebrovascular anatomy.

Observation:

  • A case of basilar artery occlusion is presented.
  • The occlusion occurred via a persistent hypoglossal artery, a rare fetal variant.
  • Contralateral vertebral artery access was absent due to a left vertebral artery terminating at the left posterior inferior cerebellar artery.

Findings:

  • Successful endovascular thrombectomy was achieved despite complex and rare cerebrovascular anatomy.
  • Preoperative identification of the persistent carotico-basilar anastomosis and contralateral vertebral artery absence was crucial.
  • This case highlights the importance of recognizing anatomical variations in emergent stroke interventions.

Implications:

  • Awareness of persistent fetal cerebrovascular anatomy is vital for interventional neurologists.
  • Advanced imaging review is critical for planning endovascular thrombectomy in complex cases.
  • Successful treatment of BAO in the setting of rare anatomical variations expands treatment possibilities.