Carotid Artery Stenting for Symptomatic Stenosis of the Cervical Carotid Artery Associated with Persistent Primitive Hypoglossal Artery: A Case Report

Objective: A case of symptomatic cervical carotid artery stenosis with persistent primitive hypoglossal artery (PPHA) treated by carotid artery stenting (CAS) with appropriate embolic protection is reported. Case Presentation: The patient was a 65-year-old male presenting with left hemiplegia. MRI revealed infarction in the right cerebral hemisphere, and cerebral angiography demonstrated stenosis affecting the proximal segment of the internal carotid artery (ICA), proximal to the origin of the PPHA. Since blood flow was observed from the PPHA to the ICA during simultaneous obstruction of the common and external carotid arteries, a filter protection device was placed in the ICA along with proximal protection, and CAS could be performed without complications. Conclusion: In performing CAS for symptomatic stenosis of the cervical carotid artery with PPHA, it is considered important to select appropriate embolic protection based on the evaluation of the direction of the blood flow of the ICA and PPHA under balloon occlusion conditions.