• Kevin A Shah and Jeffrey M Katz.
• Department of Neurosurgery, North Shore University Hospital, Manhasset, New York, USA. Electronic address: kshah8@northwell.edu.
• World Neurosurg. 2020 Jan 1; 133: 159-162.

BackgroundThe persistent trigeminal artery is the most common type of persistent fetal carotid-basilar anastomosis. Patients who are found to have a persistent trigeminal artery are more likely to harbor intracranial aneurysms, both along the persistent trigeminal artery and elsewhere in the cerebral vasculature.Case DescriptionWe report the case of a 48-year-old male who presented with a ruptured persistent trigeminal artery aneurysm arising at the trigeminal artery-basilar junction. In this patient, the trigeminal artery was the primary blood supply to the internal carotid artery due to an absent common carotid artery. He was treated successfully with balloon-assisted coil embolization and occlusion of the persistent trigeminal artery.ConclusionsAlthough several variations of the persistent trigeminal artery describe blood flow from the internal carotid to the posterior circulation, this is the first case to describe a persistent trigeminal artery that is the primary supply of the internal carotid artery due to an absent common carotid artery. Successful treatment of aneurysms of the persistent trigeminal artery may require occlusion of the artery.Copyright © 2019 Elsevier Inc. All rights reserved.

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