Abstract 194: Angioplasty and Stenting of Persistent Primitive Trigeminal Artery Stenosis in Acute Ischemic Stroke

A persistent primitive trigeminal artery (PPTA) is the most common remnant of carotid‐vertebrobasilar anastomosis during embryonic development. The PPTA usually arises from the cavernous or pre‐cavernous portion of the Internal Carotid Artery (ICA). Based on cerebral angiography and magnetic resonance angiography (MRA) data, PPTA has been identified in between 0.1% and 0.6% of the population. Amongst most cases with PPTA, the Basilar Artery (BA) is exclusively supplied from the ICA with the PPTA. There have been multiple reports of acute strokes secondary to embolism to the ICA presenting with top of the BA syndrome. Successful revascularization of the PPTA has been reported with Aspiration and Stent retriever with Thrombolysis in Cerebral Infarction (TICI) score between 2B‐3. There have also been reports of stenting to the PPTA in cases of unruptured aneurysms. Here, we describe a case where severe stenosis to the PPTA due to Intracranial Atherosclerotic Disease presented as top of the BA syndrome, requiring urgent angioplasty and stenting.