{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:07:45Z","timestamp":1776096465799,"version":"3.50.1"},"reference-count":36,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"9","license":[{"start":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T00:00:00Z","timestamp":1772409600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,3,2]]},"abstract":"\n BACKGROUND<\/jats:title>\n Mechanical thrombectomy (MT) is the established treatment for acute ischemic stroke due to large-vessel occlusion. However, rare cerebrovascular anomalies, such as a persistent hypoglossal artery (PHA), present unique challenges that require procedural modifications.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n The authors present the case of a woman in her 80s who developed sudden-onset impaired consciousness and left hemiparesis, with a National Institutes of Health Stroke Scale (NIHSS) score of 20. Imaging revealed a tandem occlusion of the right internal carotid artery (ICA) and middle cerebral artery (MCA). Notably, perfusion imaging demonstrated an extensive penumbra not only in the right MCA territory, but also in bilateral posterior cerebral artery territories, despite an anterior circulation occlusion. Angiography revealed a functionally significant PHA originating from the right ICA and supplying the entire posterior circulation. Successful recanalization was achieved with a modified Thrombolysis in Cerebral Infarction grade of 2b. The patient experienced significant neurological improvement, with an NIHSS score of 2 at the final follow-up.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n This case highlights that a PHA may function as a critical collateral pathway. Recognition of atypical perfusion patterns and preprocedural identification of vascular anomalies are essential for safe and effective MT.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25961<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25961","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T15:27:03Z","timestamp":1776094023000},"source":"Crossref","is-referenced-by-count":0,"title":["Mechanical thrombectomy for tandem internal carotid artery\u2013middle cerebral artery occlusion in a patient with a persistent hypoglossal artery: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"given":"Yudai","family":"Mihara","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Kagoshima, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0825-4537","authenticated-orcid":true,"given":"Ryutaro","family":"Makino","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Kagoshima, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yushi","family":"Nagano","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Kagoshima, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1831-9428","authenticated-orcid":true,"given":"Jun","family":"Sugata","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Kagoshima, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5680-5336","authenticated-orcid":true,"given":"Takuichiro","family":"Higashi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Kagoshima, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hitoshi","family":"Yamahata","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Kagoshima, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryosuke","family":"Hanaya","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Kagoshima, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"bib1","series-title":"Contrib Embryol","first-page":"205","article-title":"The development of the cranial arteries in the human embryo","volume":"32","author":"Padget","year":"1948","unstructured":"Padget DH.The development of the cranial arteries in the human embryo. Contrib Embryol. 1948;32:205-261."},{"issue":"6","key":"bib2","series-title":"J Vasc Surg","first-page":"774","article-title":"Anomalous carotid-basilar anastomoses in cerebrovascular surgery","volume":"7","author":"Ouriel","year":"1988","unstructured":"Ouriel KGreen RMDeWeese JA.Anomalous carotid-basilar anastomoses in cerebrovascular surgery. J Vasc Surg. 1988;7(6):774-777. doi:10.1067\/mva.1988.avs0070774"},{"issue":"1","key":"bib3","series-title":"Clin Anat","first-page":"36","article-title":"Primitive persistent carotid-basilar and carotid-vertebral anastomoses: a report of seven cases and a review of the literature","volume":"8","author":"Yilmaz","year":"1995","unstructured":"Yilmaz EIlgit ETaner D.Primitive persistent carotid-basilar and carotid-vertebral anastomoses: a report of seven cases and a review of the literature. 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Neuroradiology. 2013;55(1):17-23. doi:10.1007\/s00234-012-1074-0"},{"key":"bib6","series-title":"Neuropsychiatr Dis Treat","first-page":"29","article-title":"The effect of demographic features on aortic arch anatomy and its role in the etiology of cerebrovascular disease","volume":"14","author":"\u0130nan\u00e7","year":"2017","unstructured":"\u0130nan\u00e7 Y\u0130nan\u00e7 YAy H.The effect of demographic features on aortic arch anatomy and its role in the etiology of cerebrovascular disease. Neuropsychiatr Dis Treat. 2017;14:29-35. doi:10.2147\/NDT.S152194"},{"key":"bib7","series-title":"Front Neurol","article-title":"Persistent hypoglossal artery as a potential risk factor for simultaneous carotid and vertebrobasilar infarcts","volume":"9","author":"Jin","year":"2018","unstructured":"Jin XSun LFeng ZPersistent hypoglossal artery as a potential risk factor for simultaneous carotid and vertebrobasilar infarcts. 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Clin Neurol Neurosurg. 2024;238:108179. doi:10.1016\/j.clineuro.2024.108179"},{"issue":"1","key":"bib18","series-title":"J Stroke Cerebrovasc Dis","first-page":"176","article-title":"Cerebral infarction in both carotid and vertebrobasilar territories associated with a persistent primitive hypoglossal artery with severe dilated cardiomyopathy","volume":"23","author":"Kawano","year":"2014","unstructured":"Kawano HInatomi YHirano TYonehara T.Cerebral infarction in both carotid and vertebrobasilar territories associated with a persistent primitive hypoglossal artery with severe dilated cardiomyopathy. J Stroke Cerebrovasc Dis. 2014;23(1):176-178. doi:10.1016\/j.jstrokecerebrovasdis.2012.07.020"},{"key":"bib1","series-title":"Contrib Embryol","first-page":"205","article-title":"The development of the cranial arteries in the human embryo","volume":"32","author":"Padget","year":"1948","unstructured":"Padget DH.The development of the cranial arteries in the human embryo. Contrib Embryol. 1948;32:205-261."},{"issue":"6","key":"bib2","series-title":"J Vasc Surg","first-page":"774","article-title":"Anomalous carotid-basilar anastomoses in cerebrovascular surgery","volume":"7","author":"Ouriel","year":"1988","unstructured":"Ouriel KGreen RMDeWeese JA.Anomalous carotid-basilar anastomoses in cerebrovascular surgery. J Vasc Surg. 1988;7(6):774-777. doi:10.1067\/mva.1988.avs0070774"},{"issue":"1","key":"bib3","series-title":"Clin Anat","first-page":"36","article-title":"Primitive persistent carotid-basilar and carotid-vertebral anastomoses: a report of seven cases and a review of the literature","volume":"8","author":"Yilmaz","year":"1995","unstructured":"Yilmaz EIlgit ETaner D.Primitive persistent carotid-basilar and carotid-vertebral anastomoses: a report of seven cases and a review of the literature. Clin Anat. 1995;8(1):36-43. doi:10.1002\/ca.980080107"},{"issue":"1","key":"bib4","series-title":"J Clin Diagn Res","first-page":"TD13","article-title":"Persistent primitive hypoglossal artery (PPHA)\u2014a rare anomaly with literature review","volume":"10","author":"Srinivas","year":"2016","unstructured":"Srinivas MRVedaraju KSManjappa BHNagaraj BR.Persistent primitive hypoglossal artery (PPHA)\u2014a rare anomaly with literature review. J Clin Diagn Res. 2016;10(1):TD13-TD14. doi:10.7860\/JCDR\/2016\/15556.7116"},{"issue":"1","key":"bib5","series-title":"Neuroradiology","first-page":"17","article-title":"Persistent hypoglossal artery and its variants diagnosed by CT and MR angiography","volume":"55","author":"Uchino","year":"2013","unstructured":"Uchino ASaito NOkada YPersistent hypoglossal artery and its variants diagnosed by CT and MR angiography. Neuroradiology. 2013;55(1):17-23. doi:10.1007\/s00234-012-1074-0"},{"key":"bib6","series-title":"Neuropsychiatr Dis Treat","first-page":"29","article-title":"The effect of demographic features on aortic arch anatomy and its role in the etiology of cerebrovascular disease","volume":"14","author":"\u0130nan\u00e7","year":"2017","unstructured":"\u0130nan\u00e7 Y\u0130nan\u00e7 YAy H.The effect of demographic features on aortic arch anatomy and its role in the etiology of cerebrovascular disease. Neuropsychiatr Dis Treat. 2017;14:29-35. doi:10.2147\/NDT.S152194"},{"key":"bib7","series-title":"Front Neurol","article-title":"Persistent hypoglossal artery as a potential risk factor for simultaneous carotid and vertebrobasilar infarcts","volume":"9","author":"Jin","year":"2018","unstructured":"Jin XSun LFeng ZPersistent hypoglossal artery as a potential risk factor for simultaneous carotid and vertebrobasilar infarcts. Front Neurol. 2018;9:837. doi:10.3389\/fneur.2018.00837"},{"key":"bib8","series-title":"Congenital Anomalies of the Carotid Arteries","first-page":"35","author":"Lie","year":"1968","unstructured":"Lie TA.Congenital Anomalies of the Carotid Arteries. Excerpta Medica; 1968:35-51."},{"issue":"39","key":"bib9","series-title":"Medicine (Baltimore)","first-page":"e17151","article-title":"A persistent primitive hypoglossal artery-posterior inferior cerebellar artery convergence aneurysm treated by stent-assisted coil embolization: a case report","volume":"98","author":"Zeng","year":"2019","unstructured":"Zeng SYang DYang HXu LSXu MH.A persistent primitive hypoglossal artery-posterior inferior cerebellar artery convergence aneurysm treated by stent-assisted coil embolization: a case report. Medicine (Baltimore). 2019;98(39):e17151. doi:10.1097\/MD.0000000000017151"},{"key":"bib10","series-title":"Front Neurol","first-page":"168","article-title":"A persistent primitive hypoglossal artery as the sole supply to the brain associated with a basilar bifurcation aneurysm","volume":"8","author":"Wang","year":"2017","unstructured":"Wang MGu JLan PA persistent primitive hypoglossal artery as the sole supply to the brain associated with a basilar bifurcation aneurysm. Front Neurol. 2017;8:168. doi:10.3389\/fneur.2017.00168"},{"issue":"6","key":"bib11","series-title":"J Vasc Surg","first-page":"995","article-title":"Persistent hypoglossal artery: diagnostic and therapeutic considerations concerning carotid thromboendarterectomy","volume":"20","author":"Fantini","year":"1994","unstructured":"Fantini GAReilly LMStoney RJ.Persistent hypoglossal artery: diagnostic and therapeutic considerations concerning carotid thromboendarterectomy. J Vasc Surg. 1994;20(6):995-999. doi:10.1016\/0741-5214(94)90238-0"},{"key":"bib12","series-title":"Surg Neurol Int","first-page":"182","article-title":"Manual aspiration thrombectomy for basilar infarction in the setting of a persistent primitive hypoglossal artery: case report and review of the literature","volume":"5","author":"Voronovich","year":"2014","unstructured":"Voronovich ZGrandhi RZwagerman NTJadhav APJovin TG.Manual aspiration thrombectomy for basilar infarction in the setting of a persistent primitive hypoglossal artery: case report and review of the literature. Surg Neurol Int. 2014;5:182. doi:10.4103\/2152-7806.147412"},{"issue":"8","key":"bib13","series-title":"J Neurointerv Surg","first-page":"e30","article-title":"Basilar stroke from a persistent hypoglossal artery","volume":"9","author":"See","year":"2017","unstructured":"See APBaranoski JFFlores BCDucruet AAlbuquerque FC.Basilar stroke from a persistent hypoglossal artery. J Neurointerv Surg. 2017;9(8):e30. doi:10.1136\/neurintsurg-2016-012859.rep"},{"issue":"48","key":"bib14","series-title":"Medicine (Baltimore)","first-page":"e27998","article-title":"Endovascular treatment for acute basilar artery occlusion via persistent primitive hypoglossal artery: a case report","volume":"100","author":"Park","year":"2021","unstructured":"Park JSShin BSKang HG.Endovascular treatment for acute basilar artery occlusion via persistent primitive hypoglossal artery: a case report. Medicine (Baltimore). 2021;100(48):e27998. doi:10.1097\/MD.0000000000027998"},{"key":"bib15","series-title":"Front Neurol","article-title":"Case report: mechanical thrombectomy for acute basilar artery occlusion via persistent hypoglossal artery","volume":"14","author":"Zhang","year":"2023","unstructured":"Zhang XWang JCao ZCase report: mechanical thrombectomy for acute basilar artery occlusion via persistent hypoglossal artery. 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Clin Neurol Neurosurg. 2024;238:108179. doi:10.1016\/j.clineuro.2024.108179"},{"issue":"1","key":"bib18","series-title":"J Stroke Cerebrovasc Dis","first-page":"176","article-title":"Cerebral infarction in both carotid and vertebrobasilar territories associated with a persistent primitive hypoglossal artery with severe dilated cardiomyopathy","volume":"23","author":"Kawano","year":"2014","unstructured":"Kawano HInatomi YHirano TYonehara T.Cerebral infarction in both carotid and vertebrobasilar territories associated with a persistent primitive hypoglossal artery with severe dilated cardiomyopathy. J Stroke Cerebrovasc Dis. 2014;23(1):176-178. doi:10.1016\/j.jstrokecerebrovasdis.2012.07.020"}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/11\/9\/article-CASE25961.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/11\/9\/article-CASE25961.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/11\/9\/article-CASE25961.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T15:27:03Z","timestamp":1776094023000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/11\/9\/article-CASE25961.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,2]]},"references-count":36,"journal-issue":{"issue":"9"},"URL":"https:\/\/doi.org\/10.3171\/case25961","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,2]]}}}