Posterior Circulation Mechanical Thrombectomy through Primitive Trigeminal Artery: A Case Report

Area of Science:

• Neurology
• Vascular Surgery
• Interventional Radiology

Background:

• Primitive trigeminal artery (PTA) is a rare congenital vascular anomaly.
• Mechanical thrombectomy is a key treatment for acute ischemic stroke.
• Revascularization via PTA is infrequently reported, posing unique challenges.

Observation:

• A patient presented with acute ischemic stroke due to basilar artery occlusion, with an associated PTA.
• Mechanical thrombectomy was attempted through the PTA due to underdeveloped vertebral arteries.
• The procedure unfortunately failed to recanalize the occluded artery, and the patient demised.

Findings:

• PTA can serve as a potential, albeit complex, access route for mechanical thrombectomy in specific stroke cases.
• The anatomical variations associated with PTA can significantly increase the technical difficulty and risk of endovascular procedures.
• Failure to recanalize despite attempting thrombectomy via PTA underscores the challenges in managing stroke with this malformation.

Implications:

• This case underscores the critical need for detailed pre-procedural imaging and careful planning when considering endovascular treatment in patients with PTA.
• Understanding the risks and limitations of mechanical thrombectomy via PTA is crucial for managing patient expectations and outcomes.
• Further research is warranted to establish best practices for endovascular interventions in the presence of PTA-associated stroke.