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Double Distal Filter Protection with a Single Guiding Catheter for Internal Carotid Artery Stenosis with a Persistent
Yuta Otomo1,2,3, Shigeta Miyake1,2,4, Taisuke Akimoto2
1Department of Neurosurgery, Yokohama Brain and Spine Center, Yokohama, Kanagawa, Japan.
Objective:
Persistent primitive hypoglossal artery (PPHA) is a rare vascular anomaly that can complicate carotid artery stenting (CAS) due to its role in posterior circulation perfusion. Embolic protection is required for both the anterior and posterior circulations, which increases procedural complexity. We present a novel approach utilizing double distal filter protection (DDFP) with a single guiding catheter.
Case Presentation:
A 69-year-old man with symptomatic internal carotid artery stenosis (ICS) and coexisting PPHA underwent successful CAS using a DDFP strategy with a single guiding catheter. Two filter devices were deployed: 1 in the distal internal carotid artery and 1 in the PPHA. Stent delivery was achieved by temporarily retrieving the PPHA filter, followed by redeployment and post-dilation. No perioperative complications occurred. Imaging demonstrated adequate cerebral perfusion and high-risk plaque morphology, supporting the need for dual protection. The procedure minimized access-related risks and maintained perfusion throughout.
Conclusion:
We successfully performed CAS in a patient with PPHA using a DDFP with a single guiding catheter technique. This technique may reduce procedural complexity while maintaining robust embolic protection, offering a safe alternative to traditional dual-catheter strategies.
