ABSTRACT
We report a case of acute ischemic stroke involving both the anterior and posterior circulation associated with a persistent primitive trigeminal artery (PPTA), treated by endovascular revascularization for acute basilar artery (BA) occlusion via the PPTA. An otherwise healthy 67-year-old man experienced sudden loss of consciousness and quadriplegia. Magnetic resonance imaging showed an extensive acute infarction in the right cerebral hemisphere, and magnetic resonance angiography showed occlusion of the right middle cerebral artery (MCA) and BA. Because the volume of infarction in the territory of the right MCA was extensive, we judged the use of intravenous tissue plasminogen activator to be contraindicated. Cerebral angiography revealed hypoplasia of both vertebral arteries and the presence of a PPTA from the right internal carotid artery. A microcatheter was introduced into the BA via the PPTA and revascularization was successfully performed using a Merci Retriever with adjuvant low-dose intraarterial urokinase. After treatment, his consciousness level and right motor weakness improved. Although persistent carotid-vertebrobasilar anastomoses such as a PPTA are relatively rare vascular anomalies, if the persistent primitive artery is present, it can be an access route for mechanical thrombectomy for acute ischemic stroke.
Subject(s)
Aged , Humans , Arteries , Basilar Artery , Carotid Artery, Internal , Cerebral Angiography , Cerebrum , Consciousness , Infarction , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Middle Cerebral Artery , Quadriplegia , Stroke , Thrombectomy , Tissue Plasminogen Activator , Unconsciousness , Urokinase-Type Plasminogen Activator , Vertebral ArteryABSTRACT
We report a case of spontaneous right carotid-cavernous fistula (CCF) in a proximal segment of persistent primitive trigeminal artery (PPTA) and combined vascular anomalies such as left duplicated hypoplastic proximal posterior cerebral arteries and a variation of anterior choroidal artery supplying temporal and occipital lobe. A 45-year-old male presented with progressive right exophthalmos, diplopia, and ocular pain. With manual compression of the internal carotid artery, a cerebral angiography revealed a right CCF from a PPTA. Treatment involved the placement of detachable non-fibered and fibered coils, and use of a hyperglide balloon to protect against coil herniation into the internal carotid artery. A final angiograph revealed complete occlusion of PPTA resulted in no contrast filling of CCF.
Subject(s)
Humans , Male , Middle Aged , Arteries , Carotid Artery, Internal , Caves , Cerebral Angiography , Choroid , Diplopia , Exophthalmos , Fistula , Occipital Lobe , Posterior Cerebral ArteryABSTRACT
A 45-year-old male presented with left pulsatile tinnitus and left conjunctival chemosis after blunt head trauma. Cerebral angiography demonstrated a left carotid-cavernous sinus fistula associated with a persistent primitive trigeminal artery. The fistula was packed with detachable coils through the transvenous approach and was successfully occluded without complication, while preserving the patency of the persistent primitive trigeminal artery. The patient's symptoms resolved soon after treatment. Persistent primitive trigeminal artery can be associated with a traumatic cavernous sinus fistula and transvenous coil embolization can be a safe and effective method to immediately occlude the fistula.
Subject(s)
Humans , Male , Middle Aged , Arteries , Carotid-Cavernous Sinus Fistula , Cavernous Sinus , Cerebral Angiography , Craniocerebral Trauma , Embolization, Therapeutic , Fistula , TinnitusABSTRACT
The persistent primitive trigeminal artery is the most common of the carotid-basilovertebral anastomoses and is located in the most cephalic portion of them. Embryologically arising from the internal carotid artery in the 4mm embryo, it supplies the longitudinal neural artery. Failure of regression of the trigeminal artery in the 14mm embryo results in the persistent primitive trigeminal artery. It is associated with a vascular anomaly in 25% of the cases, such as aneurysm, arteriovenous malformation, agenesis or hypoplasia of the internal carotid artery, and moyamoya disease. The authors present a case of persistent primitive trigeminal artery aneurysm presenting with the abducens nerve palsy. The clinical features of the persistent primitive trigeminal artery aneurysm are discussed, with the review of literature.
Subject(s)
Abducens Nerve Diseases , Aneurysm , Arteries , Arteriovenous Fistula , Carotid Artery, Internal , Embryonic Structures , Equipment and Supplies , Moyamoya DiseaseABSTRACT
Persistent primitive trigeminal artery (PPTA) is the most common permanent abnormal vascular anastomosis between carotid artery and basilar artery. PPTA is a rare cerebrovascular variation and is often associated with cerebrovascular disease (CVD). Clinically, PPTA manifests itself in symptoms such as trigeminal neuralgia, oculomotor paralysis, abducens nerve paralysis, subarachnoid hemorrhage, etc. This paper aims to review 116 PPTA cases with CVD and other cerebrosis, which have ever been reported since 1983 in English or Chinese medical literature.
ABSTRACT
Persistent primitive trigeminal artery is relatively rare cerebrovascular anomaly, usually observed on angiography or at autopsy. We reported two cases of persistent primitive trigeminal artery. One is associated with spontaneous subarachnoid hemorrhage and the other intraventricular hemorrhage with scanty subarachnoid hemorrhage after minor head trauma. We reviewed the persistent primitive trigeminal artery and it's clinical significance. It's clinical significance seemed to be followed; 1) Formation of intracranial aneurysm due to increased arterial blood flow. 2) pathway for microemboli from carotid system to basilar system. 3) probable cause hemodynamic cerebral ischemia. 4) unexpected finding during surgical procedure.