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Persistent hypoglossal artery: diagnostic and therapeutic considerations concerning carotid thromboendarterectomy
G A Fantini1, L M Reilly, R J Stoney
1Department of Surgery, New York Hospital, NY 10021.
Insights
Persistent fetal arteries like the hypoglossal artery can cause confusion in cerebrovascular disease diagnosis. This study highlights two cases of persistent hypoglossal artery found during carotid endarterectomy.
Area of Science:
- Neurology
- Vascular Anatomy
- Cerebrovascular Medicine
Background:
- Fetal circulation features primitive carotid-basilar anastomoses via presegmental arteries (otic, hypoglossal, trigeminal).
- These anastomoses typically obliterate after the posterior communicating artery forms.
- Rare persistence into adulthood can lead to diagnostic challenges in cerebrovascular disease.
Abstract:
Fetal anastomotic connections between the developing internal carotid and basilar arterial systems are via the three presegmental arteries: the otic artery, the hypoglossal artery, and the trigeminal artery. After formation of the posterior communicating artery from the caudal branch of the internal carotid artery, the presegmental arteries are generally obliterated. Rarely, however, these primitive carotid-basilar anastomoses will persist into adult life, and may be detected as incidental findings at the time of cerebral angiography during evaluation of the patient with suspected cerebrovascular disease. In addition, persistence of such anastomoses may result in the coexistence of anterior and posterior circulation symptoms, precipitating diagnostic confusion. Two patients with symptoms and persistent hypoglossal artery undergoing carotid thromboendarterectomy are discussed, with emphasis on clinical presentation, diagnostic criteria and intraoperative management.