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– Head CT scan showing the PTA, a) volume rendering technique showing PTA anastomosing the left ICA with de the terminal portion of the BA, b) arrow indicating PTA originating from the left ICA, c) arrow showing hypoplastic BA proximal to the anastomosis. IC – internal carotid artery, T – trigeminal artery, B – basilar artery, P – posterior cerebral artery
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Background:
A persistent trigeminal artery (PTA) is a non-involuted embryonic vessel that connects the cavernous part of the internal carotid artery with the posterior circulation. In the adult it is associated with multiple pathological conditions including trigeminal neuralgia, ophthalmoplegia, hypopituitarism, intracavernous fistula, brain aneu...
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... Classic angiography, computer tomography angiography with contrast substance (angioCT), or magnetic resonance angiography (MRA) can diagnose this malformation, with most diagnoses occurring incidentally during MRA scans. The prevalence varies from 0.061% to 1% using MRA, angioCT, or classic angiography [4][5]. ...
... [16,19] Addressing ischemic strokes related to the PPTA presents distinct complexities for clinical neurologists. [3] Traditional endovascular thrombectomy (EVT) may be less than ideal, especially when dealing with the complex anatomy of the PPTA. [15,22] is accentuates the pressing need for innovative and advanced therapeutic methods tailored to such intricate cases. ...
... Medical management strategies vary, encompassing anticoagulation therapy and antiplatelet agents to prevent thromboembolic events associated with PPTA. In the acute phase, treatment may involve thrombolysis, [3] EVT, and antiplatelet aggregation, expanding the spectrum of available choices. [5] Against this backdrop of existing treatments, our case study introduces SWIM as a novel approach to PPTA-related stroke. ...
Background
The persistent primitive trigeminal artery (PPTA) is a persistent embryological carotid-basilar connection. Endovascular thrombectomy (EVT) for hypoplastic PPTA occlusion is a challenge. This case report aims to describe the successful recanalization of simultaneous occlusions in both the PPTA and basilar artery (BA) using the Solitaire FR (RECO SR)/Stent and Intermediate Catheter Assisting (SWIM) technique in a patient with acute cardiogenic cerebral embolism. To the best of our knowledge, this is the first report of such a case.
Case Description
We present a case of a 70-year-old female patient who presented with acute right-sided hemiparesis and altered consciousness. Digital subtraction angiography confirmed the occlusion of both the distal portion of the PPTA and the BA. The patient underwent EVT using the SWIM technique, resulting in successful recanalization and significant improvement in the patient’s condition.
Conclusion
This case report demonstrates the successful application of the SWIM technique in achieving recanalization and improving outcomes in a patient with simultaneous occlusion of the acute PPTA and BA. These findings support the potential use of EVT in similar cases.
... Type II is characterized by PTA terminating at the proximal part of the superior cerebellar artery and supplying it, while the posterior cerebral artery is supplied by the patent posterior communicating artery. Type III involves direct anastomosis of PTA with cerebellar arteries without any connection to the basilar artery [6,7]. In this case, PTA originated from the cavernous segment of the right ICA, with ipsilateral posterior communicating artery and vertebrobasilar artery dysplasia. ...
Introduction
Primitive trigeminal artery (PTA) is a rare intracranial vascular malformation, and mechanical thrombectomy and revascularization via PTA are rarely reported.
Case Presentation
We reported a case of mechanical thrombectomy through PTA in a patient who presented with sudden slurred speech and had a National Institutes of Health Stroke Scale score of 12. Digital subtraction angiography of the cerebral vasculature showed PTA formation in the right internal carotid artery cavernous segment, with acute occlusion of the distal basilar artery at the PTA junction, and bilateral vertebral arteries and proximal basilar artery were underdeveloped. Therefore, we chose mechanical thrombectomy via PTA, but unfortunately, the vessel failed to recanalize. Follow-up at 1-month post-procedure indicated that the patient had passed away. We present the endovascular process and analyze and summarize the reasons for the failure to provide a reference for subsequent mechanical thrombectomy via PTA.
Conclusions
PTA increases the risk of ischemic stroke and adds to the complexity of mechanical thrombectomy post-stroke. However, in certain situations, PTA can be used as a thrombectomy channel to increase the first-line possibility of timely endovascular treatment to save ischemic brain tissue.
... Several fetal anastomoses have been described between the carotid and vertebrobasilar circulations [1][2][3][4][5][6][7][8][9][10][11]. These anastomoses regress while the P1 segments develop, but they can occasionally persist in adult age [1][2][3][4][5][6][7][8][9][10][11]. ...
... Several fetal anastomoses have been described between the carotid and vertebrobasilar circulations [1][2][3][4][5][6][7][8][9][10][11]. These anastomoses regress while the P1 segments develop, but they can occasionally persist in adult age [1][2][3][4][5][6][7][8][9][10][11]. The persistent trigeminal artery (PTA) is the most common anastomosis found in about 85% of cases [1][2][3][4][5][6][7][8][9][10][11]. ...
... These anastomoses regress while the P1 segments develop, but they can occasionally persist in adult age [1][2][3][4][5][6][7][8][9][10][11]. The persistent trigeminal artery (PTA) is the most common anastomosis found in about 85% of cases [1][2][3][4][5][6][7][8][9][10][11]. Variants of PTA arising from the internal carotid artery (ICA) and terminating as cerebellar arteries are extremely rare [1][2][3][4][5][6][7][8][9][10][11] As the vascular system evolves, they are quickly remodelled, with the trigeminal artery being the last to disappear. ...
Persistent trigeminal artery is the most common primitive carotid basilar anastomosis that persists in adulthood. The overall incidence of persistent trigeminal artery is between 0.2 to 0.76%. PTA are known to be associated with a wide range of pathology. The aim of this study was to describe the morphological characteristics of the PTA and to emphasize its clinical significance. We examined radiographs from patients who had CT angiography undertaken for a variety of clinical reasons, performed as a part of their medical treatment at the University Institute for Radiology in Skopje, RN Macedonia. The study population included 234 patients, 130 male and 104 females, mean age 57.8 years. In one patient we found PTA with overall incidence of 0.42%. CTA revealed a left PTA that arise from the internal carotid artery and communicate with the basilar artery between the origin of the anterior inferior cerebellar artery and the superior cerebellar artery. Although anatomically interesting, an awareness of the anatomy and variations of the brain arteries is clinically important for radiologists and surgeons for save performance of procedures, and forensic pathologists since variants may have forensic consequences. Key words: anatomy, persistent trigeminal artery, computed tomography.
... In the Saltzman type 3 variant, the PTA inserts directly into one of the cerebellar arteries, without having an anastomosis with the BA. In the case of Slatzman type 3 there are 3 variants: the type 3a variant that terminates in SCA ; the type 3b variant, and the most common one, that terminates into AICA ; and type 3c variant that terminates into posterior inferior cerebellar artery (PICA) [5]. ...
A persistent trigeminal artery (PTA) is a non-involuted embryonic vessel that connects the cavernous part of the internal carotid artery with the posterior circulation. In the adult, it is usually found incidentally but can be often associated with vascular malformation, cerebral aneurysm trigeminal neuralgia and even posterior circulation strokes. We report here a case of persistant trigeminal artery as a cause of trigeminal neuralgia and its aspects found in MR imaging.
... For other authors, the PPTA may run superior or inferior to the cranial nerves III, IV, and VI [1,8]. Saltzman described three variants according to the basilar end (Table 1) [4,7,10]. In Chen's study, these variants account for 24%, 16%, and 60% [4]. ...
... Saltzman described three variants according to the basilar end (Table 1) [4,7,10]. In Chen's study, these variants account for 24%, 16%, and 60% [4]. Saltzman type III is the rarest one, with a prevalence of 0.34% in the O'uchi and O'uchi study [1]. ...
... If the thrombosis is below the PPTA, this last will have a detrimental effect. The microemboli may borrow the PPTA to pass in the basilar territory [4,10]. But, in cervical ICA stenosis, the basilar system will supply the ICA one through the PPTA [10]. ...
PurposeThis article reports a new variant of the persistent primitive trigeminal artery. This variant does not exist in Salas and Saltzman classifications.Methods
We analyzed CTA images of a 39-year-old male patient using RadiAnt. This work had clinical and research purposes.ResultsA persistent primitive trigeminal artery arose from left internal carotid artery termination. Its course was atypical, superior, and lateral to the sella turcica. At its end, it joined a duplicated basilar artery. These morphological features are new compared to Salas and Saltzman’s variants.Conclusion
Anatomists, radiologists, and neurosurgeons must know this new variant. Angiographic analysis of this variant will keep the patient safe and perform the surgery. This new variant deserves to be considered in Salas and Saltzman classifications as a new type.
... PTA accounts for approximately 85% of all persistent presegmental arteries (2). In digital subtraction angiography (DSA), PTA is observed at a rate ranging from 1 in a 1,000 to 6 in 1,000, and it is usually unilateral (2,3). In radiological examinations, almost all cases are detected incidentally. ...
... According to Da-Ping et al. (5), it is unclear whether PTA is associated with ischemic cerebrovascular disease. However, Ferreira et al. (3) reported that patients with PTA and basilar hypoplasia had hypoperfusion in the posterior fossa, and therefore were more susceptible to ischemic events. Engelhardt et al. (4) stated that as the number of collaterals increased, infarction became smaller. ...
The persistent trigeminal artery (PTA) is a persistent, primitive, embryonic anastomosis that provides the blood flow between the vertebro-basilar system and the carotid system. The presence of PTA anastomosis may create an advantage by providing collateral circulation during a stroke as in cases of leptomeningeal collaterals, external-internal carotid artery anastomoses, and the polygon of Willis. However, patients with this variation are more susceptible to the development of non-occlusive posterior arterial system infarction when they experience hypotension attacks. In the literature, there are only few case reports on non-occlusive posterior system infarction associated with PTA variation. In this case report, we present to an 81-year-old patient with posterior system infarct findings and persistent trigeminal artery variation.
... In the literature, PTAs have been more frequently observed in females than in males. However, no statistically significant difference was found in terms of sex [9,18]. Although the majority of the patients (70%) with PTAs in our study were female, there was no significant correlation between the prevalence of PTAs and sex, consistent with the literature. ...
... In patients with PTA and vertebrobasilar hypoplasia, the vascular supply to the posterior fossa may tend to decrease. Relevant literature suggests that there may be a relationship of transient ischemic attack and vertigo, which is considered as the first symptom of transient ischemic attack, with PTA [7,9,13,14,19,25]. In the present study, one patient had a chronic ischemic infarct in the right half of the bulb. ...
... PTAs can originate from different segments of the ICA. Arra'ez-Aybar et al. reported that most of the PTAs originated from the posterior wall of the cavernous segment of Fig. 4 A 44-year-old male patient with an infarct in the right half of the bulb and a PTA extending from the basilar artery to the left ICA on magnetic resonance angiography the ICA (C4) and a small number of PTAs originated from the petrous segment [9]. The C4 segment is often reported as the origin of PTAs [2,3,10,15,22]. ...
Purpose
This study aimed to investigate the prevalence of persistent trigeminal arteries (PTAs) using computed tomography (CT) angiography, emphasize its major characteristics, and compare the findings with those reported in the relevant literature.
Methods
Patients who underwent cerebral CT angiography in our radiology clinic for any preliminary diagnosis between December 2013 and December 2020 were included in this retrospective study. The patients were reviewed in terms of their age, sex, and the presence of PTAs. The localization of the PTA, vascular connection, PTA type (according to Saltzman and Salas classification), and vascular pathology at the level of anastomoses were examined in the patients with PTAs.
Results
A total of 1150 patients, (632 [55%] males and 518 [45%] females) were included in this study. A total of seven (0.6%) patients had PTAs. PTAs were located on the right and left sides in three (43%) and four (57%) patients, respectively. A total of three (43%), two (28%), and two (28%) cases were classified as types I, II, and III PTA based on the Saltzman classification, respectively. Moreover, four (57%) and three (43%) cases were lateral and medial types based on the Salas classification, respectively.
Conclusion
In conclusion, understanding the diagnosis and classification of PTAs is crucial for the diagnosis of possible vascular pathologies by neuroradiologists and physicians performing neurovascular interventional procedures or operations. If these vascular pathologies remain undetected, they may cause fatal bleeding or embolism during surgeries and endovascular procedures.
... It has been reported that the presence of PTA may also be associated with ischemic stroke [18][19][20] [9]. The C4 segment is often reported as the origin of PTAs [9,[17][18][19][20][21]. ...
... It has been reported that the presence of PTA may also be associated with ischemic stroke [18][19][20] [9]. The C4 segment is often reported as the origin of PTAs [9,[17][18][19][20][21]. Most of the PTA cases in the present study (85%) originated from the posterior wall of the cavernous segment (C4) of the ICA, and few (15%) originated from the petrous part. ...
Purpose
This study aimed to investigate the prevalence of persistent trigeminal arteries (PTAs) using computed tomography (CT) angiography, emphasize its major characteristics, and compare the findings with those reported in the relevant literature.
Methods
Patients who underwent cerebral CT angiography in our radiology clinic for any preliminary diagnosis between December 2013 and December 2020 were included in this retrospective study. The patients were reviewed in terms of their age, sex, and the presence of PTAs. The localization of the PTA, vascular connection, PTA type (according to Saltzman and Salas classification), and vascular pathology at the level of anastomoses were examined in the patients with PTAs.
Results
A total of 1150 patients, (632 [55%] males and 518 [45%] females) were included in this study. A total of seven (0.6%) patients had PTAs. PTAs were located on the right and left sides in 3 (43%) and 4 (57%) patients, respectively. A total of 3 (43%), 2 (28%), and 2 (28%) cases were classified as types I, II, and III PTA based on the Saltzman classification, respectively. Moreover, 4 (57%) and 3 (43%) cases were lateral and medial types based on the Salas classification, respectively.
Conclusion
In conclusion, understanding the diagnosis and classification of PTAs is crucial for the diagnosis of possible vascular pathologies by neuroradiologists and physicians performing neurovascular interventional procedures or operations. If these vascular pathologies remain undetected, they may cause fatal bleeding or embolism during surgeries and endovascular procedures.
... The PTA has been identified as a rare cause of cranial nerves dysfunction, including incomplete oculomotor and abducens nerve palsies, trigeminal neuralgia and hemifacial spasm. The ischemic events related to the PTA are rare and can occur through the steal phenomenon or thrombosis in anterior circulation [16,21]. Typically, persistent trigeminal artery aneurysms (PTAA) are discovered incidentally in patients with subarachnoid hemorrhage (SAH) due to the rupture of a simultaneous aneurysm in another localization. ...
The persistent trigeminal artery (PTA) is the most common fetal carotid- basilar anastomosis which may persist into adult life. In the literature there are numerous papers referring to the anatomical characteristics of this anomalous vessel. In the majority of cases PTA is an incidental finding and its clinical significance has been debated. Some authors describe the coincidence of PTA with various clinical syndromes. However, there are few reports linking PTA with the symptoms of vertebrobasilar insufficiency. We present a patient with a 3-year history of recurrent dizziness and impaired vision, precipitated by physical activity, in whom neuroimaging techniques revealed a persistent left trigeminal artery (PTA). In our case the occurrence of PTA might have been related to the clinical manifestation and the potential mechanism will be discussed.
