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Subclavian steal and a persistent trigeminal artery
Sebastian Koch1, Jose G Romano, Alejandro Forteza
1Department of Neurology, University of Miami School of Medicine, 1150 NW 14th Street, Professional Arts Center, Suite 304, Miami, FL 33136, USA. skoch@med.miami.edu
Summary
A persistent trigeminal artery (PTA) can compensate for left subclavian steal, a condition where blood flow is reversed. This rare artery may play a protective hemodynamic role in cerebrovascular disease.
Area of Science:
- Neurology
- Vascular Biology
- Medical Imaging
Background:
- Persistent trigeminal artery (PTA) is a rare cerebrovascular anomaly.
- Subclavian steal syndrome involves reversed blood flow in the vertebral artery.
Observation:
- A 73-year-old asymptomatic woman presented with a left PTA and left subclavian steal.
- Carotid duplex indicated high-grade internal carotid artery (ICA) stenosis, contradicting catheter angiography findings.
- Elevated ICA flow velocities were linked to collateral flow via the PTA.
Findings:
- Transcranial Doppler revealed an alternating flow pattern in the basilar and left vertebral arteries.
- Basilar artery flow velocity increased by 178% and left vertebral artery by 102% during brachial hyperemia.
- The PTA appeared to compensate for the subclavian steal, rerouting blood flow.
Implications:
- A persistent trigeminal artery may offer a protective hemodynamic role in cases of subclavian steal.
- Understanding PTA's function is crucial for diagnosing and managing cerebrovascular conditions.
- This case highlights the importance of advanced imaging in assessing complex vascular dynamics.