Carotid Endarterectomy in a Patient with Severe Internal Carotid Artery Stenosis with Persistent Trigeminal Artery and Ischemia of the Anterior and Posterior Circulation

Abstract

Occurrence of cerebral ischemia in the posterior circulation as a result of severe internal carotid artery disease and persistent trigeminal artery is rare. An 81-year-old man with medical history of hypertension and ischemic stroke presented with dizziness, nausea, and mild dysarthria. Magnetic resonance imaging of the brain revealed acute infarcts in the left internal carotid artery territory. CT angiogram revealed a persistent trigeminal artery (PTA) and severe atherosclerosis. The patient developed new neurological symptoms and repeat imaging revealed new acute infarcts in the PTA distribution. After undergoing a left carotid endarterectomy with no complications, the patient was discharged to a skilled nursing facility with no recurrence of ischemic stroke. This case adds a rare complication of an infrequent vascular anomaly to the limited body of the literature.

Clinical Importance of the Persistent Primitive Trigeminal Artery in Vascular Lesions and Its Role in Endovascular Treatment

“…ICA stenosis below the PPTA may be a potential source for microemboli because artery-to-artery embolism in the BA territory may occur via the PPTA with anterograde flow (77,78); in this case, the PPTA is detrimental. Carotid angioplasty can be a possible therapeutic option (77,79). In severe stenosis or occlusion of the cervical ICA, the blood flow of the PPTA can be reversed, through which the ICA territory will be supplied by the posterior circulation (80)(81)(82)(83); in this case, although the PPTA is beneficial, carotid angioplasty may be recommended to increase brain perfusion (84).…”