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AIMS Neuroscience

2025, Volume 12, Issue 3: 434-443. doi: 10.3934/Neuroscience.2025024
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Persistent primitive trigeminal artery in stroke: A review and clinical insights

  • 1.
    School of Medicine, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele-Milan, Italy
  • 2.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
  • 3.
    Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
  • 4.
    Department of Neurosurgery, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
  • 5.
    Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
  • Received: 15 August 2025 Revised: 13 September 2025 Accepted: 24 September 2025 Published: 28 September 2025

  • The persistent primitive trigeminal artery is the most common remnant of the embryonic carotid–basilar connection. While its anatomy is well documented, its clinical significance in strokes remains debated. Some studies suggest it predisposes ischemia through altered hemodynamics, whereas others report a protective role via collateral circulation. This review summarizes the current knowledge on the anatomy, imaging, and clinical implications of the persistent primitive trigeminal artery in strokes. A literature search of PubMed, Scopus, and Embase up to March 2025 identified relevant case reports, imaging studies, and clinical series. The artery typically arises from the cavernous segment of the internal carotid artery, courses alongside the trigeminal nerve, and terminates in the posterior circulation. Classification systems describe variations in its termination, course, and vascular supply. Magnetic resonance and computed tomography angiography are key diagnostic tools, each with their advantages and limitations. Evidence shows two opposing roles: either as a conduit for steal phenomena, turbulent flow, and thromboembolism or as a collateral channel that preserves cerebral perfusion during carotid or vertebrobasilar occlusion. Understanding this vessel's anatomy and potential hemodynamic effects are critical for accurate diagnoses, risk assessments, and treatment planning. Its dual nature highlights the importance of individualized evaluations and further research to clarify its role in strokes.

    Citation: Jad El Choueiri, Francesca Pellicanò, Lorenzo De Rossi, Victor Gabriel El-Hajj, Lorenzo Pellegrini, Leonardo Di Cosmo, Anthony Abi Chakra, Nakul Gokul Varma, Francesco Laurelli, Maria Pia Tropeano, Zefferino Rossini, Federico Pessina, Gabriele Capo. Persistent primitive trigeminal artery in stroke: A review and clinical insights[J]. AIMS Neuroscience, 2025, 12(3): 434-443. doi: 10.3934/Neuroscience.2025024

    Related Papers:

  • The persistent primitive trigeminal artery is the most common remnant of the embryonic carotid–basilar connection. While its anatomy is well documented, its clinical significance in strokes remains debated. Some studies suggest it predisposes ischemia through altered hemodynamics, whereas others report a protective role via collateral circulation. This review summarizes the current knowledge on the anatomy, imaging, and clinical implications of the persistent primitive trigeminal artery in strokes. A literature search of PubMed, Scopus, and Embase up to March 2025 identified relevant case reports, imaging studies, and clinical series. The artery typically arises from the cavernous segment of the internal carotid artery, courses alongside the trigeminal nerve, and terminates in the posterior circulation. Classification systems describe variations in its termination, course, and vascular supply. Magnetic resonance and computed tomography angiography are key diagnostic tools, each with their advantages and limitations. Evidence shows two opposing roles: either as a conduit for steal phenomena, turbulent flow, and thromboembolism or as a collateral channel that preserves cerebral perfusion during carotid or vertebrobasilar occlusion. Understanding this vessel's anatomy and potential hemodynamic effects are critical for accurate diagnoses, risk assessments, and treatment planning. Its dual nature highlights the importance of individualized evaluations and further research to clarify its role in strokes.



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    Conflict of interest


    The authors declare no conflict of interest.

    Authors' contributions


    J.E.C. conceived and designed the review, performed the literature search, extracted and analyzed data, and drafted substantial portions of the manuscript; F.P. contributed to study conception and design, conducted literature search and data extraction, and co-authored sections of the manuscript; L.D.R. performed literature search, data extraction, and analysis, and co-authored manuscript sections; V.G.E. participated in study conception, literature review, and data synthesis, and co-authored manuscript sections; L.P. conducted literature search, data extraction, and analysis, and co-authored manuscript sections; L.D.C. contributed to study conception and design, conducted literature search and data extraction, and co-authored sections of the manuscript; A.A.C. assisted with literature search and data extraction, and co-authored manuscript sections; N.G.V. contributed to literature review, data analysis, and co-authored manuscript sections; F.L. participated in literature search, data synthesis, and co-authored manuscript sections; M.P.T. contributed to literature review and co-authored manuscript sections; Z.R., F.P., and G.C. provided senior supervision, contributed to conceptualization and study design, and co-authored and critically revised the manuscript for technical and scientific accuracy. All authors contributed to writing and revising the manuscript, approved the final version to be published, and agree to be accountable for all aspects of the work.

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  • © 2025 the Author(s), licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0)
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