Stenting for Internal Carotid Artery Stenosis Associated with Persistent Primitive Hypoglossal Artery Using Proximal Flow Blockade and Distal Protection System: A Technical Case Report and Literature Review

We report a very rare case of internal carotid artery (ICA) stenosis associated with persistent primitive hypoglossal artery (PPHA) treated by stenting using a proximal flow blockade and distal filter protection system. A 77-year-old man with a medical history of repeated cerebral infarction was referred to our hospital for treatment of progressive ICA stenosis. Cerebral angiography revealed that the degree of stenosis was 50% and the PPHA branched just distal to the stenosis at the C2 vertebral level. Black-blood magnetic resonance imaging indicated vulnerable plaque. The stenosis was at a high location, so carotid artery stenting was employed. Under the proximal flow blockade system with occlusion of the external and common carotid artery, distal filter protection was placed in the ICA to prevent distal embolization. A self-expanding stent was successfully deployed and the patient was discharged without any neurological deficits. In stenting for the ICA stenosis associated with PPHA, the combination of a proximal flow blockade and distal protection system is reasonable and safe.