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1 1) 2) Persistent primitive proatlantal artery 1 3) 1) 2) 1) 1) 1) 1) 1) 4) 1) 2) 5) TEL: , tsuboyoshi@hotmail.com : persistent primitive proatlantal artery,,

2 JNET Journal of Neuroendovascular Therapy

3 Persistent primitive proatlantal artery PPPA 75 MRI 梗 PPPAPPPA PPPA

4 persistent primitive trigeminal artery (PPTA) persistent primitive otic artery (PPOA) persistent primitive hypoglossal artery (PPHA)persistent primitive proatlantal artery (PPPA) 叉 2 叉梗 PPPA

5 75 梗 155/84mmHg 75 / MRI 梗 Figure 1 MRA

6 Figure 23DCTA Figure 3PPPA type 梗穿梗 120mg/120mg/ 100mg/75mg/5mg/

7 梗 37 PPPA PPPA Guardwire(Medtronic, Minneapolis, MN, USA)

8 Guiding catheter 腿 6Fr. long sheathactivated clotting time(act) 250 腿 PPPA 6Fr. ENVOY STR 90cm (Cordis, Johnson & Johnson, Fremont, CA, USA) 腿 6Fr. FUBUKI ST 90cm () Guardwire 200cm Guardwire 200cm PPPA GuardwirePPPA Gateway 2.5*14mm (Boston Scientific, Natick, MA, USA) PPPAIntegrity stent 3.5*18mm(Medtronic, Minneapolis, MN, USA)

9 PPPA(Figure 4) Export PPPA60mlDebris GuardwirePPPA

10 Ljiljana 1) 24longitudinal neural plexus primitive ICAtrigeminal artery otic artery hypoglossal artery proatlantal artery 7-12mmotic arteryhypoglossal arterytrigeminal artery 2) proatlantal artery12-14mm PPTA % PPHA % 3) PPPA PPPA type C2 3 4th segmenttype

11 123rd segment PPPA PPPA type PPTA 叉 4,5) PPHA 3,4,6) 7) PPTA14-32% 8) PPHA21-26% 8,9) 梗梗

12 10,11) PPHA PPPA 12,13,14) PPPA 15,16) 2178 梗 PPPA filter protectionpppa 71 梗 PPPAprotectionPPPA (Table 1)PPPA CAS

13 12) CASembolic protection 梗 PPPA protection PPPAProtection device Filter Wire EZ Spider PPA FilterprotectionPPPA Balloon protection protectin deviceguardwire

14 PPPA protection kissing techniqueballoon PTAGuardwire PPPAPPPA

15 PPPA % 17,18)

16 1) Vasovic L, Mojsilovic M, Andelkovic Z, et al: Proatlantal intersegmental artery: a review of normal and pathological features. Childs Nerf Syst 2009; 25: ) Rao TS, Sethi PK: Persistent proatlantal artery with carotid-vertebral anastomosis. J Neurosurg 1975; 43: ) Huang M, Moisi M, Zwillman ME, et al: Transient ischemic attack in the setting of carotid atheromatous disease with a persistent primitive hypoglossal artery successfully treated with stenting: a case report. Cureus Jan 2016; 21: 464

17 4) Kempe LG, Smith DR: Trigeminal neuralgia, facial spasm, intermedius and glossopharyngeal neuralgia with persistent carotid basilar anastomosis. J Neurosurg 1969; 31: ) Bosco D, Consoli D, Lanza PL, et al: Complete oculomotor palsy by persistent trigeminal artery. Neurol Sci 2010; 31: ) Melia D, Wetter A, Brassel F, et al: Intermittent hypoglossal nerve palsy caused by a calcified persistent hypoglossal artery: an uncommon neurovascular compression syndrome. J Neurol Sci 2012; 323: ) Uhlig S, Kurzepa J, Chehab EC, et al: Persistemt trigeminal artery as a rare cause of ischemic lesion and migraine-like headache. Folia Morphol 2015; 74:

18 8) Yukawa H, Koizumi T, Hoshimaru M, et al: Persistent primitive hypoglossal artery associated with a ruptured basilar aneurysm: case report. JNET J Neuroendovasc Ther 2009; 3: ) Teo M, Bhattacharya J, Suttner N: Persistent hypoglossal artery--an increased risk for intracranial aneurysms? Br J Neurosurg 2012; 26: ) Lancu D, Anxionnat R, Bracard S: Brainstem infarction in a patient with internal carotid dissection and persistent trigeminal artery: a case report. BMC Med Imaging 2010; 10: ) Rousseaux M, Combelle G, Krivosic Y, et al: Multifocal infarction of the basilar trunk region. Persistence of a trigeminal artery. Rev Neurol 1985; 144: 49-52

19 12) Hirota N, Hokaku H, Katoh A, et al: Carotid artery stenting for symptomatic stenosis of cervical carotid artery with a persistent proatlantal artery: case report. JNET J Neuroendovasc Ther 2010; 4: ) Kanazawa R, Ishihara M, Okawara H, et al: A successful treatment with carotid artery severe stenosis with ipsilateral persistent primitive hypoglossal artery: case report and review of the literature. Minim Invas Neurosurg 2008; 51: ) Nii K, Aikawa H, Tsutsumi M: Carotid artery stenting in a patient with internal carotid artery stenosis and ipsilateral persistent primitive hypoglossal artery presenting with transient ischemia of the vertebrobailar system. Neurol Med Child 2010; 50:

20 15) Eto A, Nakai K, Aikawa H, et al: Plaque shift at the ipsilateral internal carotid artery after stenting due to stenosis of a persistent primitive proatlantal artery. JNET J Neuroendovasc Ther 2014; 8: ) Ohhashi G, Inoya H: Stenting for cerebral infarction due to stenosis of a persistent primitive proatlantal artery: a case report. No Shinkei Geka 2013; 41: ) Albuquerque FC, Fiorella D, Han P, et al: A reappraisal of angioplasty and stenting for the treatment of vertebral origin stenosis. Neurosurgery 2003; 53: ) Janssens E, Leclerc X, Gautier C et al: Percutaneous transluminal angioplasty of proximal vertebral artery stenosis: long-term clinical follow up of 16 consecutive patients. Neuroradiology 2004;46: 81-84

21 Figure 1: MRI 梗 A: B: Figure 2: DSA (A) 3D-DSA (B)PPPA (C) Figure 3: 3DCTA(A,B,C)PPPA() 1()

22 Figure 4: (A)() (B)PPPA (C)()PPPA

23 / 1 78/ 2 71/ 75/ PPPA (PPPAIC) PPPA Table 1 PPPA PPPA: FilterWire EZ IC: PPPA: Spider FX IC: Carotid Guard Wire PPPA: Carotid Guard Wire IC: Carotid Guard Wire Driver Sprint mm PROTÉGÉ 8-6mm 30mm Integrity mm GR GR GR

24 Fig.1 Fig.2

25 Fig.3 Fig.4

1 Case report 後硬膜動脈から延髄外側への穿通枝を認めた 1 例 A case of Lateral medullary artery arise from the Posterior meningeal artery 伊藤真史泉孝嗣西堀正洋今井資玉利洋介塚田哲也石田衛クロ

1 Case report 後硬膜動脈から延髄外側への穿通枝を認めた 1 例 A case of Lateral medullary artery arise from the Posterior meningeal artery 伊藤真史泉孝嗣西堀正洋今井資玉利洋介塚田哲也石田衛クロップ明日香若林俊彦 Masashi I, Takashi I, Nishihori M, Tasuku