PMC5128690_01
Axial T2-weighted MR image shows a persistent trigeminal artery (arrow) coursing from the cavernous left internal carotid artery posteriorly and medially to anastomose with the midbasilar artery.
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It demonstrated a persistent trigeminal artery (TGA), an anomalous intracranial artery connecting the left internal carotid artery to the midbasilar artery (Figure 1).
PMC5128690_02
Camera in the AP plane. A contrast injection reveals anomalous origin of the left common carotid artery from the roof of the main pulmonary artery.
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The wedge catheter was then gently advanced over the wire, and a contrast hand injection was performed, revealing the anomalous left common carotid artery (LCCA) arising from the cranial aspect of the main pulmonary artery (Figure 2).
(a) Camera in the AP plane. An angiogram (early phase) is performed in the transverse aorta, revealing a right aortic arch with aberrant origin of the left subclavian artery and absence of the left common carotid artery. (b) Camera in the AP plane. An angiogram (late arterial phase) reveals retrograde opacification of the left common carotid artery (arrow) draining into the left pulmonary artery.
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Absence of an aortic origin of the carotid was confirmed with a supravalvar aortic angiogram (Figure 3(a)), demonstrating a right aortic arch with aberrant origin of the left subclavian artery, and the right common carotid artery arising as the first branch from the ascending aorta. In the late arterial phase of the injection, retrograde opacification of the LCCA was observed, draining into the branch pulmonary arteries (Figure 3(b)), reflecting preferential flow from the higher pressure cerebral arterial bed to the lower pressure pulmonary bed.