Rupture of persistent primitive trigeminal artery-basilar artery aneurysm managed with stent-assisted coiling

Abstract

Persistent primitive trigeminal artery (PPTA), a fetal carotid-basilar anastomosis, is the most common embryological vascular remnant persisting into adult age. However, reported cases associated with cerebral aneurysms are rare. A 33-year-old female presented with an extremely rare PPTA-basilar artery (PPTA-BA) aneurysm manifesting as subarachnoid hemorrhage. Computed tomography revealed subarachnoid bleeding in the prepontine cistern, and cerebral angiography disclosed a PPTA-BA aneurysm. The aneurysm was managed with stent-assisted coiling technique to achieve complete obliteration. The patient was discharged without neurological deficits 2 weeks later. At 6 months follow-up, the patient is doing well and has returned to her previous daily activities. PPTA-BA aneurysms usually present with cranial nerve palsy and sometimes with carotid-cavernous fistulae if they rupture. Their deep seating favors interventional management as a first option and this case illustrates the efficacy and safety of endovascular treatment. This case adds to the evidence that endovascular techniques are a safe and effective tool in managing aneurysms of the primitive trigeminal artery. Even in cases where the anastomosis itself is not preserved, the patient can be managed satisfactorily, provided that the patency of the basilar and the carotid artery are kept, like in our patient.