Scepter-Mini Balloon Assisted Coil Embolization of an Intracranial Arterial Aneurysm in a Child with PHACE Syndrome via a Persistent Trigeminal Artery

Cerebral vascular malformations constitute one of the key abnormalities in children with PHACE syndrome, which is characterized by Plaque like cutaneous hemangiomas, Posterior fossa abnormalities, arterial Cerebrovascular and Eye abnormalities, with or without Sternal clefts (PHACES when sternal clefts are present), and associated midline anomalies. Both moyamoya arteriopathy and intracranial aneurysms have been reported in children with this syndrome. Herein, we report the successful treatment of a growing left posterior-communicating artery aneurysm arising from an aberrant left internal carotid artery (LICA) with balloon assisted coiling (BAC) in a child with PHACE syndrome. We circumvented the limitations posed by the narrow caliber of the proximal LICA, by successfully navigating a coiling microcatheter from the basilar artery into the LICA <i>via</i> a persistent trigeminal artery. BAC was then achieved using a Scepter Mini balloon microcatheter for aneurysm neck remodelling.

Simultaneous anterior and posterior circulation stroke secondary to large-vessel atherosclerotic disease associated with persistent trigeminal artery: a case report

Context: Cardioembolic events are the main cause of simultaneous anterior and posterior circulation stroke. Anatomical variants of the circle of Willis represent another rare mecanism. Persistent trigeminal artery is a carotid–vertebrobasilar anastomosis related to an increased risk of aneurysms, vascular malformations and stroke. Case report: A 67-year-old diabetic man was brought to the emergency department with a history of sudden onset of left hemiparesis. Neurologic finginds showed a hemiparesis, hemianesthesia and heminegligence (all left sided), right hemiataxia and a dysarthria. Brain Magnetic Resonance study revealed a isquemic stroke in right middle cerebral artery, right posterior cerebral artery (PCA) and bilateral superior cerebellar arteries (SUCA). Computed tomography angiography showed a right internal carotid artery oclusion and a persistent trigeminal artery. Causitive Classification System (CCS) revealed a large-vessel atherosclerotic stroke. A non-habitual simultaneous affection of PCA and SUCA resulted from a carotid artery embolization associated with anterior and posterior territories anostomosis by the persistent trigeminal artery. Secondary prevention consisted of aspirin 100mg/day and cardiovascular risk factor control. The patient remained free from others cardiovascular events, in rehabilitation, at the moment, in category 3 from the Ranking Modified Scale. Conclusions: The presence of a persistent trigeminal artery, in the context of a internal carotid oclusion, can chance our stroke-mecanism interpretation. Simultaneous anterior and posterior circulation stroke are compatible with large-vessel aterosclerotic disease.