Management paradigms of persistent primitive trigeminal artery aneurysms: A systematic review and analysis of techniques and complications from 1960s to 2022: From conservative to surgical to endovascular, how far along the right path are we?

Abstract

Introduction Aneurysms of persistent primitive trigeminal artery (PPTAAs) are increasingly reported and commonly managed by endovascular (EN) techniques. There are no systematic reviews or meta-analyses which analyse outcomes and complications of treatment modalities for PPTAAs. We aim to highlight the change in trend of management of PPTAAs and to identify clinical and radiological parameters which may influence management paradigms. Methodology A systematic search of literature was done in PubMed, Embase, Google Scholar, Cochrane library and Medline using keywords ‘persistent primitive trigeminal artery’, ’aneurysms’, ‘embolization’, ‘surgical clipping’, etc. Only cases reporting aneurysms of PPTA were included. Three subgroups, such as conservative, open surgical (OS) and EN interventional, were studied for outcome evaluation. In the EN subgroup, relation of clinical and radiological parameters with outcome (complete/partial occlusion) was analysed using Microsoft Excel Data Analysis ToolPak. Results Of the 101 articles found eligible for assessment, 54 were analysed quantitatively. Mortality in the conservative group was 12.5% and OS group was 9.09%. After EN treatment, complete angiographic occlusion was seen in 88.89% PPTAAs and 5.5% warranted retreatment. In the EN subgroup, location ( p=0.17), shape ( p=0.69), Saltzman circulation ( p=0.26) or status of rupture ( p=0.08) did not significantly impact angiographic occlusion outcome. Multivariate regression analysis showed 6.6% influence of independent variables, that is, age, gender, aneurysm location, side, shape (saccular/fusiform), rupture status and type of Saltzman circulation on aneurysm occlusion outcome [F(7,27) =1.34] ( p=0.27). Total mortality reported in the EN group was 8.57%. Conclusion Clinical or radiological parameters do not influence angiographic occlusion outcome. Although EN techniques are successful, meticulous reporting of outcomes and complications is important.

Successful endovascular thrombectomy using solitaire FR stent with intermediate catheter assisting technique for acute persistent primitive trigeminal artery and basilar artery occlusion: A case report and literature review

“…[ 1 , 20 ] Recognized for its association with various cerebrovascular diseases, such as cerebral hemorrhage and ischemic stroke, the PPTA also relates to arteriovenous malformations, aneurysms, carotid-cavernous fistulas, and vascular nerve compression syndromes. [ 16 , 19 ]…”

“…[1,20] Recognized for its association with various cerebrovascular diseases, such as cerebral hemorrhage and ischemic stroke, the PPTA also relates to arteriovenous malformations, aneurysms, carotidcavernous fistulas, and vascular nerve compression syndromes. [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.…”