# Mechanical Thrombectomy for Anterior Cerebral Artery Occlusion in a Patient With a Persistent Trigeminal Artery: A Rare Anomaly With Complex Comorbidities

## TL;DR

A rare case of stroke in a patient with a persistent trigeminal artery and multiple health issues highlights the challenges of mechanical thrombectomy and the importance of timely treatment.

## Contribution

This case report highlights the complexities of mechanical thrombectomy in the presence of a persistent trigeminal artery and severe comorbidities.

## Key findings

- Mechanical thrombectomy successfully recanalized the anterior cerebral artery despite a persistent trigeminal artery.
- Neurological recovery was limited due to advanced atherosclerosis and comorbidities.
- The case underscores the need for rapid intervention and multidisciplinary care in complex stroke scenarios.

## Abstract

Anterior cerebral artery occlusion is a critical cause of ischemic stroke with potentially severe outcomes if not treated promptly. Mechanical thrombectomy has become the cornerstone therapy for large vessel occlusions in the anterior circulation. However, the presence of a persistent trigeminal artery, a rare embryological anastomosis, can introduce diagnostic and technical complexities, especially in patients with significant comorbidities such as hypertension, diabetes, heart failure, and chronic kidney disease.

We describe a 56-year-old woman with poorly controlled diabetes mellitus, severe hypertension, hyperlipidemia, advanced stage five chronic kidney disease, and coronary artery disease who was initially found unconscious. Upon regaining consciousness, she presented with dense left-sided hemiparesis, facial weakness, dysarthria, and eye deviation, resulting in a National Institutes of Health Stroke Scale score of 12. A non-contrast head computed tomography scan revealed hypodensity in the right cerebellum; however, subsequent computed tomography angiography confirmed an occlusion of the anterior cerebral artery, consistent with an anterior circulation stroke. Digital subtraction angiography further revealed a persistent trigeminal artery originating from the right internal carotid artery and contributing to the supply of the anterior cerebral artery. Urgent mechanical thrombectomy led to successful recanalization. Despite this, her neurological recovery remained limited, likely due to advanced atherosclerosis, multiple comorbidities, and some delay in treatment. She required prolonged rehabilitation and assistance with activities of daily living.

This case emphasizes the need for rapid assessment and endovascular intervention in anterior cerebral artery occlusions, even when complicated by unusual vascular variants and severe systemic disease. A persistent trigeminal artery can alter expected hemodynamic patterns and pose technical challenges during thrombectomy. Multidisciplinary collaboration, individualized care, and meticulous risk-factor management are pivotal to optimizing outcomes in these complex scenarios.