Neurointervention.  2016 Sep;11(2):131-134. 10.5469/neuroint.2016.11.2.131.

Dual Stent-Assisted Coil Embolization for Fusiform Aneurysm Arising From Persistent Trigeminal Artery

• Ajeet G
• John D

• KMID: 2350692
• DOI: http://doi.org/10.5469/neuroint.2016.11.2.131

Abstract

Aneurysms of the persistent trigeminal artery (PTA) trunk are exceptionally rare and have a high risk for rupture. Dual stent placement through each internal carotid and basilar artery for endovascular coil embolization of a fusiform aneurysm arising from the PTA has not been described in the literature. A 44-year-old female with a history of chronic headache was identified to have a fusiform aneurysm arising from medially coursing adult type, Saltzman type 3 PTA trunk. Sacrifice of the PTA trunk inclusive of the aneurysm was performed with dual stent placement through each basilar and internal carotid artery across their respective junctions with the PTA. Six-month follow-up angiography showed complete occlusion of the PTA and the aneurysm. The patient's symptoms resolved. Our case demonstrated that the sacrifice of an adult type, Saltzman type 3 PTA inclusive of an associated fusiform aneurysm is feasible with dual stent-assisted coil embolization.

Keyword

Endovascular coil embolization; Fusiform aneurysm; Persistent trigeminal artery

MeSH Terms

Adult
Aneurysm*
Angiography
Arteries*
Basilar Artery
Carotid Artery, Internal
Embolization, Therapeutic*
Female
Follow-Up Studies
Headache Disorders
Humans
Rupture
Stents

Figure

• 

  Fig. 1 Frontal (A) and lateral (B) projection un-subtracted Digital Subtraction Angiography (DSA) of simultaneous right vertebral and left ICA (dotted arrow) injections, demonstrate a medial coursing, adult type, Saltzman Type 3 Primitive Persistent Trigeminal Artery (PTA) (white arrow) with a 9 mm aneurysm centered within the trunk (black arrow). Surface shaded 3D rendition (C) of left ICA injection identifies the afferent (white thick) and efferent (thin white) segments of the trunk relative to the fusiform aneurysm (black arrow).

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  Fig. 2 Lateral projection fluoroscopic spot view (A) showing the Neuroform stents within the basilar artery (black arrow) and left ICA (white arrow). Lateral projection over-laid digital road map of simultaneous right vertebral and left ICA injections (B) demonstrating retrograde micro-catheter placement with coil embolization of the efferent PTA segment (black arrow). Lateral projection over-laid digital road map of left ICA injection (C) showing antegrade micro-catheter placement with coil embolization of the aneurysm (black arrow). Frontal projection digital subtraction angiography of the left ICA (D) showing coil occlusion of the afferent aspect of the PTA (black arrow).

• 

  Fig. 3 Lateral (A) and frontal (B) projection Digital Subtraction Angiography (DSA) of simultaneous right vertebral and left ICA injections, demonstrate complete sacrifice of the PTA trunk and aneurysm (black arrow). Surface shaded 3D (C) rendition of left ICA injection shows occlusion of the aneurysm and trunk (white arrow).

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