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Persistent primitive lateral basilovertebral anastomosis-rethinking vertebrobasilar junction fenestration.

George Triantafyllou1,2, Panagiotis Papadopoulos-Manolarakis1,3, Nikolaos-Achilleas Arkoudis4,5

  • 1Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, 11527, Athens, Greece.

Surgical and Radiologic Anatomy : SRA
|September 3, 2025
PubMed
Summary

Rare arterial rings at the vertebrobasilar junction (VBJ), likely persistent primitive lateral basilovertebral anastomosis (PLBVA) segments, were identified. These rare findings require careful CTA assessment for safe interpretation and procedures.

Keywords:
Arterial ringComputed tomography angiographyFenestrationNeuroradiological anatomyPrimitive lateral basilovertebral anastomosisVertebrobasilar junction

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Area of Science:

  • Vascular anatomy
  • Embryology
  • Radiology

Background:

  • Arterial variations at the vertebrobasilar junction (VBJ) are uncommon.
  • Persistent primitive lateral basilovertebral anastomosis (PLBVA) is a rare embryological remnant.

Purpose of the Study:

  • To describe and analyze two rare cases of arterial rings at the VBJ.
  • To explore the embryological origin and clinical significance of these arterial rings.

Main Methods:

  • Retrospective review of 505 computed tomography angiography (CTA) scans.
  • Multiplanar reconstruction and 3D volume rendering for anatomical characterization.

Main Results:

  • Two cases (0.4%) of arterial rings at the VBJ were identified.
  • These rings represent persistent segments of the PLBVA, not true fenestrations.
  • No significant asymmetry or hypoplasia of the involved arteries was noted.

Conclusions:

  • VBJ arterial rings are rare embryological remnants of PLBVA.
  • These variations can complicate radiologic interpretation and endovascular procedures.
  • Accurate CTA identification is crucial for patient safety and diagnostic accuracy.