Basilar Artery Aneurysm Treated with Coil Embolization Via Persistent Primitive Trigeminal Artery

The trigeminal artery is an anastomosis between the embryonic precursors of the vertebrobasilar and carotid systems, and may persist into adult life. The association of the persistent primitive trigeminal artery (PTA) with cerebral aneurysm is well documented in the literature and, in general, aneurysms are located in the anterior circulation. We describe a patient who presented with a panencephalic Fisher III subarachnoid hemorrhage due to rupture of an intracranial aneurysm. Digital arteriography showed a saccular aneurysm in the middle third of the basilar artery, adjacent to the junction with a persistent trigeminal artery. She was submitted to endovascular treatment with embolization of the basilar artery aneurysm with coils. Aneurysms at the PTA junction with the basilar artery are rare. This paper describes a case of PTA associated with an aneurysm in the basilar artery at PTA junction and briefly reviews the literature.

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Coil embolisation of multiple cerebral aneurysms with lateral type I persistent primitive trigeminal artery: A case report and literature review

Interventional Neuroradiology ◽

10.1177/1591019919859507 ◽

2019 ◽

Vol 25 (6) ◽

pp. 628-634

Author(s):

Zheng Wan ◽

Hao Meng ◽

Ning Xu ◽

Tianyi Liu ◽

Zhongping Chen ◽

...

Keyword(s):

Basilar Artery ◽

Cerebral Aneurysms ◽

Artery Aneurysm ◽

Anterior Communicating Artery ◽

Type I ◽

Trigeminal Artery ◽

Coil Embolisation ◽

Persistent Primitive Trigeminal Artery ◽

Primitive Trigeminal Artery

The primitive trigeminal artery is an anastomotic vessel of the carotid–basilar artery system that occurs only transiently during the embryonic period. Persistent primitive trigeminal artery occurs in approximately 0.1–0.6% of the population. Here, we report the case of a 60-year-old woman with Fisher II grade subarachnoid haemorrhage. Computed tomography angiography demonstrated a lateral, Saltzman type I persistent primitive trigeminal artery with three cerebral aneurysms, including one anterior communicating artery aneurysm, one suspicious right anterior choroidal artery aneurysm and one distal basilar artery aneurysm supplied by the persistent primitive trigeminal artery. All three aneurysms were treated with coil embolisation. At the 8-month follow-up, the anterior communicating artery aneurysm had a neck remnant, the other two aneurysms exhibited complete occlusion. Persistent primitive trigeminal artery with multiple cerebral aneurysms is extremely rare, and only seven cases of persistent primitive trigeminal artery with multiple cerebral aneurysms have previously been reported in publications that included information on treatment. Most aneurysms were treated by open surgery. This is the first report of coil embolisation treatment of multiple aneurysms in persistent primitive trigeminal artery patients with follow-up results, and provides relevant and valuable information about the persistent primitive trigeminal artery and the endovascular treatment of multiple aneurysms in persistent primitive trigeminal artery patients.

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