Double-Balloon Remodeling for Coil Embolization of a Primitive Trigeminal Artery Variant Aneurysm

Abstract

<jats:p> Here we describe the case of a patient with a wide-necked unruptured aneurysm arising at origin of a persistent primitive trigeminal artery (PTA) variant from the right internal carotid artery (ICA), supplying the territory of the right superior cerebellar artery and the anterior inferior cerebellar artery. To preserve the ICA and the PTA variant, coil embolization of the aneurysm was performed using a double-balloon remodeling technique (HyperForm™ and Hyper-Glide™ Occlusion Balloon Systems; ev3 Endovascular Inc., Irvine, CA, USA). The association of a PTA variant with an aneurysm is very rare. To our knowledge, this is the first description of the use of coil embolization using double-balloon remodeling to treat a PTA variant aneurysm. This technique permits complete embolization and reduces the risk of cerebral and cerebellar ischemia. </jats:p>

Parent Artery Occlusion for Symptomatic Large Internal Carotid Artery Aneurysm with Primitive Trigeminal Artery Variant: A Case Report

“…Seven cases of cerebral aneurysm complicating PTAv have been reported to date, 5 , 7 – 12) with surgical treatment performed in two cases 8 , 11) and endovascular treatment in five cases. 5 , 7 , 9 , 10 , 12) Hanabusa et al treated ruptured cerebral aneurysms associated with distal PTAv by embolizing the main trunk of the PTAv proximal to the aneurysm 7) but Yang et al treated a spindle-shaped ruptured aneurysm associated with a proximal PTAv by embolizing the cerebral aneurysm and the PTAv proximal to the aneurysm. 12) In this case, the PTAv was perfusing the right AICA region but analysis of the right SCA and PICA revealed that the PTAv was perfusing the same region in a complementary style, leading to parent artery occlusion with no ischemic complications.…”

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

“…EVT is a good option for treating these ruptured or symptomatic aneurysms, including reconstructive or deconstructive techniques. Selective coiling with or without balloon/stent assistance can be used to reconstruct PPTA with bifurcation aneurysm or saccular dissection ( Figure 4 ) ( 31 , 34 ).…”

Persistent primitive trigeminal artery associated with monocular blindness and external carotid-vertebral artery anastomosis

“… 1 , 2 The advances in neuroimaging techniques have led to the increased detection of PPTA and prompted considerable research interest in its clinical significance. 3 , 4 Studies have shown that in approximately 25% of the cases, PPTA occurs in combination with other cerebrovascular lesions, such as aneurysms, 5 cavernous fistula, and arteriovenous malformation, 6 , 7 which are clinically manifested as trigeminal neuralgia, paralysis of the oculomotor nerve or abducens nerve, or palsy of the trochlear nerve. 2 These conditions can lead to compression of the brain stem and, eventually, cerebral ischemia.…”