Tratamento endovascular do aneurisma dissecante da artéria cerebral posterior associado à artéria hipoglossa persistente: relato de caso

Conexões embriológicas persistentes entre as circulações anterior e posterior são entidades raras. A artéria hipoglossa persistente é a segunda anastomose carotídeo-basilar persistente mais comum. Como está frequentemente associada à hipoplasia das artérias vertebrais, apresenta um desafio durante as intervenções endovasculares. Apresentamos o caso de uma mulher de 32 anos que apresentou cefaleia occipital com duração de quatro semanas. A angiografia por ressonância magnética mostrou artérias vertebrais hipoplásicas com artéria hipoglossa persistente surgindo do segmento cervical da artéria carótida interna esquerda e suprindo toda a circulação posterior com um aneurisma dissecante da artéria cerebral posterior direita. A oclusão endovascular do vaso parental foi realizada para o aneurisma da dissecção da artéria cerebral posterior pela passagem de cateter guia, microfio e microcateter pela artéria hipoglossa persistente, pois as artérias vertebrais eram hipoplásicas. Após a intervenção, a paciente não apresentou déficit neurológico e recebeu alta em uma condição estável.

Palavras-chave:
artéria hipoglossa persistente; anastomose carotídeo-basilar; aneurisma dissecante

Autoria

Vivek Murumkar

Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India.National Institute of Mental Health and NeurosciencesIndiaBengaluru, Karnataka, IndiaDepartment of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India.

Sameer Peer

http://orcid.org/0000-0002-7674-5004

Jitender Saini

http://orcid.org/0000-0002-5218-0264

Hanumanthapura Ramalingaiah Arvinda

No conflicts of interest declared concerning the publication of this article.

Correspondence Jitender Saini Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS) Bengaluru, 560029 - Karnataka, India Tel.: +919980584819 E-mail: jsaini76@gmail.com

Author information VM - MD, Senior Resident, Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences. SP - MBBS, MD, Senior Resident, Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences. JS - MD, DM, Additional Professor, Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences. HRA - MD, DM, Professor, Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences.

Author contributions Conception and design: VM Analysis and interpretation: SP Data collection: HRA Writing the article: VM, SP Critical revision of the article: JS, HRA Final approval of the article*: VM, SP, JS, HRA Statistical analysis: N/A Overall responsibility: JS * All authors have read and approved of the final version of the article submitted to J Vasc Bras.

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Figure 1
Diagnosis of the dissecting aneurysm of the right posterior cerebral artery associated with persistent hypoglossal artery. a) Maximum intensity projection magnetic resonance angiogram image showing a dissecting aneurysm involving the P2-P3 segment of the right posterior cerebral artery (white arrow). A persistent hypoglossal artery (blue arrow) is noted medial to the left internal carotid artery (black arrow) and joining the basilar trunk. b) Lateral maximum intensity projection magnetic resonance angiogram showing the persistent hypoglossal artery (white arrow) arising from the dorsal aspect of the left internal carotid artery (black arrow). c) Axial magnetic resonance angiogram section at the level of the hypoglossal canal showing the persistent hypoglossal artery (white arrow) traversing the left hypoglossal canal. d) Maximum intensity projection magnetic resonance angiogram of the neck showing bilateral hypoplasia of vertebral arteries (black arrows).

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Figure 2
Endovascular approach through the persistent hypoglossal artery for occlusion of the right P2-P3 segment. a) Digital subtraction angiogram with the guide catheter in the left internal carotid artery (white arrow) showing the persistent hypoglossal artery (blue arrow) arising from the cervical segment of the left internal carotid artery and supplying the posterior circulation. A dissecting aneurysm (black arrow) is noted involving the P2-P3 segment of the right posterior cerebral artery with narrowing of the segment proximal to the aneurysm. b) Digital subtraction angiogram with guide catheter in the persistent hypoglossal artery (white arrow). The microcatheter (black arrow) was navigated through the PHA into the right posterior cerebral artery to reach the desired location for parent artery occlusion. c) Parent artery occlusion of the P2-P3 segment of the right posterior cerebral artery with coils (black arrow). No residual filling of the aneurysm is seen. d) Maximum intensity projection of the magnetic resonance angiogram showing no residual filling of the aneurysm with occlusion of the P2-P3 segment of the right posterior cerebral artery (black arrow).

Figure 1 Diagnosis of the dissecting aneurysm of the right posterior cerebral artery associated with persistent hypoglossal artery. a) Maximum intensity projection magnetic resonance angiogram image showing a dissecting aneurysm involving the P2-P3 segment of the right posterior cerebral artery (white arrow). A persistent hypoglossal artery (blue arrow) is noted medial to the left internal carotid artery (black arrow) and joining the basilar trunk. b) Lateral maximum intensity projection magnetic resonance angiogram showing the persistent hypoglossal artery (white arrow) arising from the dorsal aspect of the left internal carotid artery (black arrow). c) Axial magnetic resonance angiogram section at the level of the hypoglossal canal showing the persistent hypoglossal artery (white arrow) traversing the left hypoglossal canal. d) Maximum intensity projection magnetic resonance angiogram of the neck showing bilateral hypoplasia of vertebral arteries (black arrows).

Figure 2 Endovascular approach through the persistent hypoglossal artery for occlusion of the right P2-P3 segment. a) Digital subtraction angiogram with the guide catheter in the left internal carotid artery (white arrow) showing the persistent hypoglossal artery (blue arrow) arising from the cervical segment of the left internal carotid artery and supplying the posterior circulation. A dissecting aneurysm (black arrow) is noted involving the P2-P3 segment of the right posterior cerebral artery with narrowing of the segment proximal to the aneurysm. b) Digital subtraction angiogram with guide catheter in the persistent hypoglossal artery (white arrow). The microcatheter (black arrow) was navigated through the PHA into the right posterior cerebral artery to reach the desired location for parent artery occlusion. c) Parent artery occlusion of the P2-P3 segment of the right posterior cerebral artery with coils (black arrow). No residual filling of the aneurysm is seen. d) Maximum intensity projection of the magnetic resonance angiogram showing no residual filling of the aneurysm with occlusion of the P2-P3 segment of the right posterior cerebral artery (black arrow).

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Tratamento endovascular do aneurisma dissecante da artéria cerebral posterior associado à artéria hipoglossa persistente: relato de caso

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[1] No conflicts of interest declared concerning the publication of this article.