When Carotid Artery Stenosis Cause Posterior Fossa Infarct. An Unusual Case of Persistent Hypoglossal Artery

Maysam Shehab*, Rotem Sivan Hoffmann, Claudia Granbichler, Menashe Haddad, Adi Bachar

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: The primitive anastomosis between the carotid artery and the vertebrobasilar arteries usually regress, in rare cases they persist beyond fetal development and form vascular anomalies such as primitive persistent hypoglossal artery(PPHA), with prevalence of 0.02–0.1% in the general population. Case Report: A 77-year-old female presented with aphasia, weakness of both legs and arms. Computed Tomography Angiography (CTA) revealed subacute infarct in right pones, severe stenosis of the right internal carotid artery(RICA) and ipsilateral PPHA. We performed Right carotid artery stenting (CAS) using a distal filter into the PPHA to protect the posterior circulation, with good result. Discussion: The posterior circulation was utterly dependent on the RICA, therefore, despite the general notion that carotid stenosis is usually associated with anterior circulation infarcts, in cases having vascular anomalies it may cause a posterior stroke. Carotid artery stenting offer a safe and simple solution, however the use of EPD requires special considerations regarding decision on the suitable protection technique and placement. Conclusion: Neurological symptoms in the presence of carotid artery stenosis and PPHA can manifest as ischemia of the anterior and/or the posterior circulation. In our opinion, CAS gives a simple and safe treatment solution.

Original languageEnglish
Pages (from-to)919-922
Number of pages4
JournalVascular and Endovascular Surgery
Issue number8
StatePublished - Nov 2023
Externally publishedYes


  • carotid artery stenting,carotid endarterectomy
  • persistent carotid–vertebrobasilar fetal anastomosis
  • persistent hypoglossal artery
  • stroke


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