Carotid artery stenting for symptomatic stenosis of cervical internal carotid artery associated with persistent primitive proatlantal artery type I: case report

Abstract

We report the case of a 77-year-old female patient with symptomatic cervical internal carotid artery stenosis associated with persistent primitive proatlantal artery (PPPA) type I. She was admitted with total aphasia and severe right hemiparesis. Diffusion-weighted imaging revealed multiple infarctions in the watershed area of the left cerebral hemisphere. Digital subtraction angiography revealed severe carotid stenosis just proximal to the PPPA in the left internal carotid artery. The lesion had a massive unstable plaque, and the stenosis exhibited marked progression; therefore, carotid artery stenting (CAS) was planned. Due to concerns regarding debris migration to the vertebrobasilar system via the PPPA, CAS was performed after the intentional PPPA occlusion with coils. Risk of posterior-circulation ischemia during CAS should be considered in patients with primitive carotid–basilar anastomoses.