Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2023;17(1):22-26.
doi: 10.5797/jnet.cr.2022-0029. Epub 2022 Dec 15.

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

Ryohei Ono  1 , Masayuki Sato  1 , Sho Okune  2 , Tenyu Hino  2 , Taisuke Akimoto  1 , Yoshiro Ito  1 , Aiki Marushima  1 , Mikito Hayakawa  2 , Eiichi Ishikawa  1 , Yuji Matsumaru  1   2
Affiliations
Case Reports

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

Ryohei Ono et al. J Neuroendovasc Ther. 2023.

Abstract

Objective: To report a case of symptomatic large cerebral aneurysm of the internal carotid artery (ICA), associated with a primitive trigeminal artery variant (PTAv), which was treated with a balloon occlusion test (BOT) to evaluate ischemic tolerance.

Case presentation: A 79-year-old woman was diagnosed with a symptomatic large cerebral aneurysm of the ICA bifurcating the PTAv due to diplopia. After confirming the ischemic tolerance of the perfusion area and PTAv by BOT, we performed ICA parent artery occlusion with selective embolization of the PTAv. Postoperative MRI showed no ischemic lesion and the diplopia was resolved.

Conclusion: ICA parent artery occlusion with PTAv selective embolization after evaluation by BOT is useful in the treatment of large aneurysms.

Keywords: balloon occlusion test; cerebral aneurysm; parent artery occlusion; primitive trigeminal artery variant.

PubMed Disclaimer

Conflict of interest statement

Dr. Yuji Matsumaru has received honoraria (such as lecture fees) from Stryker, Medtronic, and Kaneka Corporation. The other authors declare no conflict of interests.

Figures

Fig. 1
Fig. 1. Initial MRI showing a large aneurysm (arrows) of the right ICA in the cavernous sinus with findings suggestive of partial thrombosis. (A) T1-weighted image, (B) T2-weighted image, and (C) time-of-flight-MRA. ICA: internal carotid artery
Fig. 2
Fig. 2. Pretreatment right internal carotid angiography showing a large aneurysm of the right ICA in the cavernous sinus with a PTAv bifurcated from the aneurysm proximal neck. (A) Anterior–posterior view, (B) lateral view, and (C) 3D rotation angiography. ICA: internal carotid artery; PTAv: primitive trigeminal artery variant
Fig. 3
Fig. 3. BOT images. (A) Live image of BOT showing balloon (arrow) dilation in the ICA including PTAv. (B) Pan-aortography early venous phase showing left–right differences. (C) Right vertebral angiography under BOT: Blood flow from the right VA to the BA and retrograde right AICA can be seen. AICA: anterior inferior cerebellar artery; BA: basilar artery; BOT: balloon occlusion test; ICA: internal carotid artery; PTAv: primitive trigeminal artery variant; VA: vertebral artery
Fig. 4
Fig. 4. Images from the coil embolization. (A) Superselective angiogram of the PTAv showing blood flow in the right AICA region. (B) PTAv embolization with coils (arrow: PTAv embolization site, arrowheads: microcatheter). (C) Live image of parent artery occlusion of the right ICA with coils. (D) Left internal carotid angiography after occlusion showing good right ICA territory blood flow via the anterior communicating artery. (E) Right VA angiography after occlusion showing retrograde blood flow in the AICA territory (or region) (arrow: AICA region perfused with leptomeningeal anastomosis). AICA: anterior inferior cerebellar artery; ICA: internal carotid artery; PTAv: primitive trigeminal artery variant; VA: vertebral artery
Fig. 5
Fig. 5. MRI on the day after surgery (A and B: diffusion-weighted image) showing no high-intensity signal and 6 months after surgery (C: T2-weighted image and D: time-of-flight-MRA maximum intensity projection) showing the aneurysm had almost disappeared.
See this image and copyright information in PMC

References

    1. Liu D, Lv M, Li Y, et al. . Technical failure of giant supraclinoid aneurysm after internal carotid artery occlusion. A report of three cases. Interv Neuroradiol 2014; 20: 736–742. - PMC - PubMed
    1. Enomoto T, Sato A, Maki Y. Carotid-cavernous sinus fistula caused by rupture of a primitive trigeminal artery aneurysm. J Neurosurg 1977; 46: 373–376. - PubMed
    1. Komiyama M. Functional anatomy of the brain and spinal vessels. Second edition, Osaka: MEDICUS SHUPPAN Publishers, 2013, 94–95. (in Japanese)
    1. Gregg L, Gailloud P. The role of the primitive lateral basilovertebral anastomosis of padget in variations of the vertebrobasilar arterial system. Anat Rec (Hoboken) 2017; 300: 2025–2038. - PubMed
    1. Nishio A, Nishijima Y, Komiyama M, et al. . Primitive trigeminal artery variant aneurysm treated with Guglielmi detachable coils: case report. Neurol Med Chir (Tokyo) 2001; 41: 446–449. - PubMed

Publication types