Endovascular treatment for unruptured aneurysm associated with persistent primitive trigeminal artery: a case report and literature review

Murai, Satoshi; Sugiu, Kenji; Hishikawa, Tomohito; Hiramatsu, Masafumi; Nishihiro, Shingo; Kidani, Naoya; Takahashi, Yu; Date, Isao

doi:10.1007/s00701-018-3767-6

Cited by 12 publications

(12 citation statements)

References 15 publications

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“…The incidence of cerebral aneurysms associated with a persistent PTA is approximately 4%, similar to that of the general population; 11 however, the incidence that is associated with a PPHA is much higher (26.9%–27.6%). 1 , 2 Of these aneurysms, 31.4% are located at the PPHA-BA junction and 53% are found in the posterior circulation.…”

Section: Discussionmentioning

confidence: 79%

Endovascular treatment of a ruptured aneurysm arising from the proximal end of a partial vertebrobasilar duplication with a contralateral prominent persistent primitive hypoglossal artery: illustrative case

Genkai

Okamoto

Nomura

et al. 2021

Journal of Neurosurgery: Case Lessons

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BACKGROUND Ruptured aneurysms associated with a partial vertebrobasilar duplication or a persistent primitive hypoglossal artery (PPHA) have been reported. Only rarely has endovascular treatment of ruptured aneurysms in association with both vascular variations been reported. OBSERVATIONS A 66-year-old woman experienced the sudden onset of a severe headache caused by a subarachnoid hemorrhage. Cerebral angiograms demonstrated a prominent PPHA originating from the left internal carotid artery at the C2 vertebral level and a partial vertebrobasilar duplication between the hypoplastic right vertebral artery and proximal basilar artery with a small aneurysm at the proximal end of the duplication from where the anterior spinal artery originated. The left vertebral artery was aplastic. A microcatheter was introduced into the aneurysm via the PPHA under the control of high blood flow, using a balloon-assisted technique. The aneurysm was completely obliterated with a coil. Although small cerebellar and cerebral infarcts developed during the procedure, the patient was discharged without neurological symptoms. LESSONS To avoid serious neurological complications, precise analysis of the complex vascular anatomy, including the anterior spinal artery and hemodynamics, is clinically important for endovascular therapy of cerebral aneurysms in patients with an association between a partial vertebrobasilar duplication and a PPHA.

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Section: Discussionmentioning

confidence: 79%

Endovascular treatment of a ruptured aneurysm arising from the proximal end of a partial vertebrobasilar duplication with a contralateral prominent persistent primitive hypoglossal artery: illustrative case

Genkai

Okamoto

Nomura

et al. 2021

Journal of Neurosurgery: Case Lessons

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“…Lasjaunias et al mentioned the proximal duplication of the ACA is as frequent as 8% in patients with aneurysms. 13 Furthermore, abnormally frequent aneurysm formation at the origin of a persistent primitive artery, particularly aneurysms at persistent trigeminal arteries 16 and persistent hypoglossal arteries, 17 are well known. Interestingly, these reports suggest that such specific aneurysms on an arterial anomaly are found in patients of a relatively younger age.…”

Section: Discussionmentioning

confidence: 99%

Unruptured Paraclinoid Carotid Aneurysms Occur More Frequently in Younger Ages

et al. 2021

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Purpose: We investigated the age distribution of cerebral saccular aneurysms in various locations to clarify the differences by location and discuss the mechanism of formation.Materials and Methods: We retrospectively assessed clinical material obtained from 1,252 unruptured aneurysms treated with endovascular embolization between 2004 and 2019. Age, sex, laterality, and size were investigated by the location of aneurysms, classified as cavernous internal carotid artery (ICA), paraclinoid ICA, supraclinoid ICA, anterior communicating artery, anterior cerebral artery, middle cerebral artery, basilar artery complex, and posterior inferior cerebellar artery. Paraclinoid aneurysms were subclassified into 3 patterns according to their projecting direction: S-type, with superior protrusion; M-type, with medial protrusion; and P-type, with posteroinferior protrusion.Results: There was no significant difference by location for sex, laterality, and size. The mean age of patients with paraclinoid aneurysms (56.5 years old) was significantly lower than that of other aneurysm patients (64.3 years old). Notably, 40% of the patients with M-type aneurysms were <50 years old. This percentage was significantly higher than that of aneurysms at other locations (P<0.05).Conclusion: We found a young female predominance for patients with paraclinoid carotid aneurysms. This study may suggest that congenital factors contribute to paraclinoid aneurysm formation as well acquired factors, such as hemodynamic stress, atherosclerotic wall damage, and local inflammation.

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“…But as with typical wide-necked aneurysms, wide-necked PPTA aneurysms usually necessitates using adjunctive techniques such as stent-or balloon-assisted techniques. 13,15) When considering the strategies for treating PPTA aneurysms, operators should focus on the lesion site and anatomical features, that is Saltzman type and VA-BA system development. For…”

Section: Discussionmentioning

confidence: 99%

“…In the literature, there are six reported incidence of stent-assisted treatments for PPTA aneurysms (Table 1). [15][16][17][18][19][20] Including the two cases presented herein, five aneurysms were at the ICA-PPTA, one was at the PPTA trunk, and two were at the PPTA-BA. Four cases were classified as Saltzman type 1; four were classified as types 2 or 3.…”

Section: Endovascular Treatmentmentioning

confidence: 99%

Treatment of Aneurysms in Persistent Primitive Trigeminal Arteries with Stent-Assisted Coil Embolization

Sakaï

Ando

Chihara

et al. 2021

JNET

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Persistent primitive trigeminal artery (PPTA) is a rare condition in which a fetal carotid-basilar anastomosis persists into adulthood. PPTA aneurysms often necessitate endovascular treatment and adjunctive techniques, such as stent-or balloon-assisted techniques, are sometimes selected. This case report describes two women in their sixties with unruptured right PPTA aneurysms who underwent stent-assisted coil embolization procedures, with consideration of the anatomical features in each case.Case Presentations: One patient presented with an aneurysm at the bifurcation of the PPTA and the basilar artery (BA), which was classified as Saltzman type 1 with a hypoplastic vertebral artery (VA)-BA system. A stent was deployed from the BA to the PPTA to cover the neck of the aneurysm and coil embolization was performed. The second patient presented with an aneurysm at the bifurcation of the PPTA and the internal carotid artery (ICA), which was classified as Saltzman type 2 with a hypoplastic VA-BA system. A stent was deployed from the PPTA to the petrous segment of the ICA covering the neck of the aneurysm and coil embolization was performed. In both patients, the 1-year follow-up digital subtraction angiography (DSA) showed that the aneurysms had not recurred. Conclusion:The PPTA aneurysms were successfully treated with stent-assisted coil embolization. The treatment strategy should be devised in accordance with both the lesion site and the PPTA variant. Keywords▶ persistent primitive trigeminal artery, aneurysm, stent, coil embolization This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives International License.

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Endovascular treatment for unruptured aneurysm associated with persistent primitive trigeminal artery: a case report and literature review

Cited by 12 publications

References 15 publications

Endovascular treatment of a ruptured aneurysm arising from the proximal end of a partial vertebrobasilar duplication with a contralateral prominent persistent primitive hypoglossal artery: illustrative case

Endovascular treatment of a ruptured aneurysm arising from the proximal end of a partial vertebrobasilar duplication with a contralateral prominent persistent primitive hypoglossal artery: illustrative case

Unruptured Paraclinoid Carotid Aneurysms Occur More Frequently in Younger Ages

Treatment of Aneurysms in Persistent Primitive Trigeminal Arteries with Stent-Assisted Coil Embolization

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