2022 年 34 巻 2 号 p. 60-64
Objective: Most of the case reports regarding relations between persistent primitive trigeminal artery (PPTA) and ischemic stroke indicate that the existence of the PPTA can lead to posterior circulation ischemia in the internal carotid artery (ICA) occlusion. We report a case of ICA occlusion due to the dissection in which PPTA played an important role as a collateral pathway.
Case report: A 47-year-old male presented with a sudden left hemiparesis and dysarthria. Magnetic resonance imaging (MRI) showed acute ischemic lesions in the right cerebral hemisphere and the right ICA occlusion. We started intravenous infusion of recombinant tissue-type plasminogen activator and performed digital subtraction angiography. Right common carotid artery angiography showed the right ICA occlusion in the cervical portion. Vertebral artery angiography demonstrated a collateral flow to the right ICA via PPTA. The neurological deficit of the patient improved gradually. After days, right ICA recanalized but it remained severe stenosis and was diagnosed ICA dissection. We performed carotid artery stenting and he was discharged from our hospital with no neurological deficit.
Conclusion: The existence of the PPTA is not only harmful in the ICA occlusion. It may play an important role as a collateral pathway in certain instance.