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

Background: The appearance of sequential bilateral aneurysms in patients with persistent primitive trigeminal artery (PTA) is not described in the literature. No clear guidelines on screening and follow-up of patients with incidental PTAs for the detection of associated lesions have been established. Case Description: A 55-year-old lady presented with occasional headaches. Detailed evaluation showed a left ophthalmic segment internal carotid artery (ICA) aneurysm measuring (11.2 × 5.5) mm. A bovine aortic arch configuration (type III) and a persistent left PTA were identified. A pipeline flex flow diverter was placed and aneurysm was coiled. Follow-up angiography after 6 months showed a completely occluded aneurysm with preserved PTA and a new aneurysm in the right ICA ophthalmic segment measuring 3.5 × 1.5 mm. It was followed up serially with angiography which revealed significant increase in 6 months. The base measured 5.4 mm and two blebs 3.1 mm and 2.5 mm had appeared on the dome. A SUPRASS flow diverter was placed across this aneurysm. Serial follow-up showed complete occlusion of the left aneurysm and significant reduction in filling of the right aneurysm. A review of the literature identified 34 cases of incidental PTAs associated with 50 aneurysms with increased prevalence of anterior circulation aneurysms in patients with incidental PTA. Conclusion: Sequential angiography of a patient with incidental PTA and an ICA aneurysm shows presence of a new aneurysm in contralateral circulation and its progression in size and morphology. Detailed large-scale studies are needed to assess the impact of incidental PTA on aneurysm development and management.

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“…[ 12 , 9 ] PTA has been used a conduit for passing endovascular catheter for therapy of aneurysms in nearby circulation. [ 7 , 17 ]…”

Section: Discussionmentioning

confidence: 99%

Sequential aneurysms with incidental persistent primitive trigeminal artery: Is this association purely coincidental? A case study and review of the literature in search for a pathobiological mechanism

Sreenivasan

Agarwal

Roychowdhury

et al. 2022

Surgical Neurology International

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“…POA is the rarest, and there is scarce evidence to prove its existence. Each of them has its own characteristics of origin on ICA, running route and afflux position of posterior circulation to distinguish in adulthood ( 13 ). The PPHA originates from the cervical segment of ICA at C1 to C3 level, and runs through the hypoglossal canal to enter the intracranial space along with the twelfth cranial nerve.…”

Section: Discussionmentioning

confidence: 99%

Concurrence of multiple aneurysms, extreme coiling of the extracranial internal carotid artery and ipsilateral persistent primitive hypoglossal artery: A case report and literature review

Wan

Liu

et al. 2022

Front. Neurol.

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BackgroundThe primitive hypoglossal artery (PHA) is an anastomotic vessel of the carotid-basilar artery system that is prevalent only transiently during the embryonic period. Persistent primitive hypoglossal artery (PPHA) is a rare vessel variation in which PHA exists persistently in adulthood and occurs in approximately 0.02–0.1% of the population. Tortuosity of the extracranial internal carotid artery (ICA) is relatively common, impacting 10–43% of the population, and is caused by either congenital or acquired factors. It is still unknown whether PPHA and tortuosity of extracranial ICA are associated. Here, we present a case report of the concurrence of three types of pathologies of the carotid artery: extreme coiling of the extracranial internal carotid artery, multiple aneurysms and persistent primitive hypoglossal artery.Case descriptionA 66-year-old woman suffered intermittent headaches, dizziness and numbness of the right eyelid for 5 years. Magnetic resonance angiography performed in a local hospital reported an aneurysm of the posterior communicating artery segment of the left ICA and a left PPHA. Digital subtraction angiography conducted after admission showed a PPHA originating from the left cervical ICA and an extremely coiling segment of the ICA distal to the beginning of PPHA. Except for the aneurysm of the posterior communicating artery segment of the left ICA, multiple aneurysms were found at the coiling segment of the ICA.ConclusionTo the best of our knowledge, this is the first report of PPHA accompanied by an adjacent, extremely coiling ICA. There are no reports of similar tortuous ICAs to this extent or at this position. Including aneurysms, three types of pathologies suggest their congenital origin, and a review of the literature infers the probable association of these lesions.

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“…It is not uncommon for PTA to be found associated to intracranial vascular pathology, especially intracranial aneurysms [9]. However, Arteriovenous Malformations (AVMs) remain a much less studied subject, with only a few cases reported.…”

Section: Introductionmentioning

confidence: 99%

Persistent Trigeminal Artery associated to an Occipital Arteriovenous Malformation: Case report and literature review

Rodriguez,

Martínez,

Baracaldo

et al. 2022

Preprint

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Persistent Trigeminal Artery or Persistent Primitive Trigeminal Artery (PTA) is the most common carotid-basilar anastomosis in both cadaveric and live patient studies. Although several studies have linked PTA to different vascular pathologies such as cerebral aneurisms, association between PTA and Arteriovenous Malformations (AVMs) remains scarce. We present the case of a 21-year-old male who was diagnosed with a right occipital AVM associated to an ipsilateral PTA. A literature review of the PTA, the results of a PUBMED search regarding the combined presence of these findings and a brief discussion providing insight into the implications for treatment is included in this case report.

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

Cited by 6 publications

References 34 publications

Sequential aneurysms with incidental persistent primitive trigeminal artery: Is this association purely coincidental? A case study and review of the literature in search for a pathobiological mechanism

Sequential aneurysms with incidental persistent primitive trigeminal artery: Is this association purely coincidental? A case study and review of the literature in search for a pathobiological mechanism

Concurrence of multiple aneurysms, extreme coiling of the extracranial internal carotid artery and ipsilateral persistent primitive hypoglossal artery: A case report and literature review

Persistent Trigeminal Artery associated to an Occipital Arteriovenous Malformation: Case report and literature review

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