Republished: Basilar stroke from a persistent hypoglossal artery

2017 ◽  
Vol 9 (8) ◽  
pp. e30-e30 ◽  
Author(s):  
Alfred P See ◽  
Jacob F Baranoski ◽  
Bruno C Flores ◽  
Andrew Ducruet ◽  
Felipe C Albuquerque
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Left Vertebral Artery ◽  
Cross Sectional ◽  
Persistent Hypoglossal Artery ◽  
Arterial Access ◽  
Hypoglossal Artery ◽  
Left Posterior ◽  
Cerebellar Artery ◽  
Cross Sectional Imaging ◽  
Basilar Occlusion

Occlusion of the basilar artery can be treated with endovascular thrombectomy, although the results have not been well studied. Persistent fetal cerebrovascular anatomy can lead to unusual presentation of carotid atherosclerotic disease and can be a barrier to successful mechanical thrombectomy if not recognized. This case presents a rare persistent carotico–basilar anastomosis which resulted in basilar occlusion via the persistent hypoglossal artery and coincident absence of contralateral vertebral arterial access due to a left vertebral artery terminating in the left posterior inferior cerebellar artery. Preoperative recognition of this anatomy afforded by review of cross-sectional imaging was critical to success during this emergent procedure.

scholarly journals Persistent hypoglossal artery aneurysm: Case report and qualitative systematic review

2018 ◽  
Vol 25 (2) ◽  
pp. 164-171
Author(s):  
George H Tse ◽  
Andrew Martin ◽  
Richard A Dyde ◽  
Stuart C Coley
Keyword(s):  
Systematic Review ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Endovascular Coiling ◽  
Persistent Hypoglossal Artery ◽  
Randomised Study ◽  
Hypoglossal Artery ◽  
Qualitative Systematic Review ◽  
Cerebellar Artery ◽  
Patient Reported

A persistent hypoglossal artery was first described in 1889 and is one of the more common anatomical variations arising from aberration in normal development. Endovascular coiling has been recognised as a robust treatment for acutely ruptured intracranial arterial aneurysms, although specific data regarding an aneurysm arising from a persistent hypoglossal artery is lacking due to the low incidence. Here we report both the oldest patient reported to be treated with a persistent hypoglossal artery-associated aneurysm and also explicitly report endovascular treatment of a persistent hypoglossal artery aneurysm arising at the posterior inferior cerebellar artery origin. Qualitative systematic review of the available medical literature demonstrates limited evidence regarding treatment of persistent hypoglossal artery-associated aneurysms with the majority being carried out via open surgery. Ruptured posterior inferior cerebellar artery aneurysm arising from a persistent hypoglossal artery can be successfully and safely treated by endovascular therapy via the persistent hypoglossal artery. Randomised study of this situation is unlikely to be feasible; however, qualitative review of the literature reveals six such aneurysms that have been treated surgically, and this case appears to be the first via an endovascular means.

Persistent Hypoglossal Artery Associated with a Ruptured Ipsilateral Posterior Inferior Cerebellar Artery Aneurysm

2007 ◽  
Vol 20 (5) ◽  
pp. 570-573 ◽  
Author(s):  
E. Uysal ◽  
M. Velioglu ◽  
E. Kara ◽  
S. Albayram ◽  
C. Islak ◽  
...  
Keyword(s):  
Rare Case ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Ruptured Aneurysm ◽  
Persistent Hypoglossal Artery ◽  
Hypoglossal Artery ◽  
Endovascular Occlusion ◽  
Cerebellar Artery

A rare case of persistent hypoglossal artery in conjuction with a ruptured aneurysm at the left proximal posterior inferior cerebellar artery (PICA) is presented. A ruptured PICA aneurysm was successfully treated by endovascular occlusion of the aneurym with coiling.

scholarly journals Direct puncture of the V3 segment of the vertebral artery in acute basilar artery stroke: an alternative approach in desperate circumstances

2019 ◽  
Vol 12 (8) ◽  
pp. e231335 ◽  
Author(s):  
Sean Thomas O’Reilly ◽  
Ian Rennie ◽  
Jim McIlmoyle ◽  
Graham Smyth
Keyword(s):  
Vertebral Artery ◽  
Basilar Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Left Vertebral Artery ◽  
Basilar Artery Thrombosis ◽  
Direct Puncture ◽  
Alternative Approach ◽  
Cerebellar Artery ◽  
First Pass ◽  
The Right

A patient in his mid-40s presented with acute basilar artery thrombosis 7 hours postsymptom onset. Initial attempts to perform mechanical thrombectomy (MT) via the femoral and radial arterial approaches were unsuccessful as the left vertebral artery (VA) was occluded at its origin and the right VA terminated in the posterior inferior cerebellar artery territory, without contribution to the basilar system. MT was thus performed following ultrasound-guided direct arterial puncture of the left VA in its V3 segment, with antegrade advancement of a 4 French radial access sheath. First pass thrombolyisis in cerebral infarction (TICI) 3 recanalisation achieved with a 6 mm Solitaire stent retriever and concurrent aspiration on the 4 French sheath. Vertebral closure achieved with manual compression.

Treatment of aneurysms by excision or trapping with arterial reimplantation or interpositional grafting

1996 ◽  
Vol 85 (1) ◽  
pp. 178-185 ◽  
Author(s):  
Sang Youl Lee ◽  
Laligam N. Sekhar
Keyword(s):  
Superficial Temporal Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Giant Aneurysm ◽  
Temporal Artery ◽  
Left Vertebral Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Content Type ◽  
First Case ◽  
Cerebellar Artery ◽  
Fine Print

✓ The authors report three cases of ruptured, large or giant aneurysms that were treated by excision or trapping, followed by revascularization of distal vessels by means of arterial reimplantation or superficial temporal artery interpositional grafting. In the first case, a large serpentine aneurysm arising from the anterior temporal branch of the right middle cerebral artery (MCA) was excised and the distal segment of the anterior temporal artery was reimplanted into one of the branches of the MCA. In the second case, a giant aneurysm, fusiform in shape, arose from the rolandic branch of the MCA. This aneurysm was totally excised and the M3 branch in which it had been contained was reconstructed with an arterial interpositional graft. In the third case the patient, who presented with a subarachnoid hemorrhage, had a dissecting aneurysm that involved the distal portion of the left vertebral artery. In this case the posterior inferior cerebellar artery (PICA) arose from the wall of the aneurysm and coursed onward to supply the brainstem. This aneurysm was managed by trapping and the PICA was reimplanted into the ipsilateral large anterior inferior cerebellar artery. None of the patients suffered a postoperative stroke and all recovered to a good or excellent postoperative condition. These techniques allowed complete isolation of the aneurysm from the normal blood circulation and preserved the blood flow through the distal vessel that came out of the aneurysm. These techniques should be considered as alternatives when traditional means of cerebral revascularization are not feasible.

Combined surgical and endovascular treatment of a giant vertebral artery aneurysm in a child

1994 ◽  
Vol 81 (2) ◽  
pp. 304-307 ◽  
Author(s):  
Mazen H. Khayata ◽  
Robert F. Spetzler ◽  
Jan J. A. Mooy ◽  
James M. Herman ◽  
Harold L. Rekate
Keyword(s):  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Mass Effect ◽  
Left Vertebral Artery ◽  
Parent Artery ◽  
Content Type ◽  
Cerebellar Artery ◽  
Coil Occlusion ◽  
Surgical Bypass

✓ The case is presented of a 5-year-old child who suffered a subarachnoid hemorrhage from a giant left vertebral artery-posterior inferior cerebellar artery (PICA) aneurysm. Initial treatment consisted of surgical occlusion of the parent vertebral artery combined with a PICA-to-PICA bypass. Because of persistent filling of the aneurysm, the left PICA was occluded at its takeoff from the aneurysm. Endovascular coil occlusion of the aneurysm and the distal left vertebral artery enabled complete elimination of the aneurysm. Follow-up magnetic resonance imaging and arteriography performed 6 months postoperatively showed persistent occlusion and elimination of the mass effect. Combined surgical bypass and endovascular occlusion of the parent artery may be a useful adjunct in the management of these aneurysms.

Anastomosis Between the Ascending Pharyngeal Artery and the Posterior Inferior Cerebellar Artery Through the Jugular Foramen

2015 ◽  
Vol 12 (2) ◽  
pp. 163-167
Author(s):  
Khaled Effendi ◽  
Elsa Magro ◽  
Jean-Christophe Gentric ◽  
Tim E Darsaut ◽  
Jean Raymond ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Jugular Foramen ◽  
Left Vertebral Artery ◽  
Cadaveric Specimen ◽  
3 Dimensional ◽  
Ascending Pharyngeal Artery ◽  
Cerebellar Artery ◽  
Direct Anastomosis ◽  
Posterior Division

Abstract BACKGROUND The ascending pharyngeal artery (APA) may, in very rare cases, supply the posterior inferior cerebellar artery (PICA). In reported cases, when such is the case, the ipsilateral vertebral artery (VA) does not supply the PICA, and most of the time it is hypoplastic. OBJECTIVE To describe a unique cadaveric observation of a direct anastomosis between the posterior division (neuromeningeal) of the jugular branch of the APA and the PICA, where the PICA is also supplied by a normal-size VA. METHODS A direct connection between the APA and the PICA was examined in a cadaveric specimen using a 3-dimensional endoscope and a surgical microscope. RESULTS The enlarged jugular branch of the posterior division of the APA entered intracranially via the jugular foramen in its pars vascularis. It then connected directly with the lateral medullary segment of the PICA. The first segment of the PICA originated from a left vertebral artery of normal size and continued its normal course beyond the junction with the jugular branch of the APA. CONCLUSION Both the VA and the jugular branch of the APA may simultaneously supply the PICA territory. Recognition of this anatomic variant is relevant when planning surgical or endovascular treatments.

scholarly journals Progressive enlargement of a previously coiled posterior inferior cerebellar artery aneurysm

2015 ◽  
Author(s):  
Michael Karsy ◽  
Aaron Cutler ◽  
Christian Bowers ◽  
Richard Schmidt
Keyword(s):  
Relevant Literature ◽  
Multidisciplinary Treatment ◽  
Posterior Inferior Cerebellar Artery ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Mass Effect ◽  
Left Vertebral Artery ◽  
Endovascular Coiling ◽  
Ct Angiogram ◽  
Cerebellar Artery

Multidisciplinary treatment of cerebral aneurysms includes endovascular coiling and open neurosurgical clipping techniques, however our understanding of long-term outcomes after coiling of large cerebral aneurysms remains limited. We present a case involving the development of a previously coiled posterior inferior cerebellar artery (PICA) aneurysm in a 64-year-old man with lesion enlargement and symptomatic mass effect. CT angiogram demonstrated a 3.9×2.6×2.4-cm partially thrombosed aneurysm adjacent to the left vertebral artery. The patient underwent resection to relieve the compressive effect. We discuss the efficacy of endovascular coiling and surgical clipping in this case as well as review the relevant literature.

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