Persistent trigeminal artery incidentally found in a patient with brain posterior system infarction: a rare case report

Abstract

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.

Keywords

• Persistent trigeminal artery
• posterior arterial system infarction
• hypotension

References

1. Albay S, Kastamoni Y, Koyuncu E. Embryonal kalıntı arterler. SDÜ Tıp Fakültesi Derg 2012; 19: 62-7.
2. Sulima K, Chojdak-Łukasiewicz J, Paradowski B, Guziński M. Persistent trigeminal artery as a rare cause of vertebrobasilar insufficiency. Folia Morphol 2022; 81-3: 785-90
3. Ferreira A, Coelho PS, Cruz VT. Persistent trigeminal artery in a patient with posterior circulation stroke treated with rt-PA: case report. BMC Neurol 2019; 19: 1-6.
4. Engelhardt J, El Hage G, Bojanowski MW. Persistent trigeminal artery as collateral circulation in ischemic stroke. World Neurosurg 2021; 148: 67-9.
5. Lyu DP, Wang Y, Wang K, Yao M, Wu YF, Zhou ZH. Acute cerebral infarction in a patient with persistent trigeminal artery and homolateral hypoplasia of internal carotid artery distal anastomosis: a case report and a mini review of the literature. J Stroke Cerebrovasc Dis 2019; 28: 104388.
6. Hiramatsu R, Ohnishi H, Kawabata S, Miyachi S, Kuroiwa T. Successful recanalization for internal carotid artery occlusion with persistent primitive trigeminal artery manifesting only as ischemia of the posterior circulation. BMC Neurol 2016; 16: 1-6.