Successful mechanical thrombectomy using a combined technique for internal carotid artery occlusion with persistent primitive trigeminal artery

BACKGROUND: The prevalence of persistent primitive trigeminal artery (PPTA) has been reported to be 0.1-0.6%. We report the successful recanalization of internal carotid artery (ICA) without embolization to new vascular territory (ENT) using a combined technique in a case of ICA occlusion with PPTA. CASE DESCRIPTION: A 65-year-old female presented with sudden consciousness disorder. The Glasgow Coma Scale score was 7 (E1, V1, M5) and National Institutes of Health Stroke Scale score was 28. Magnetic resonance diffusion-weighted imaging showed areas of high signal intensity in the left frontal lobe, parietal lobe, insular cortex, and corona radiata. Magnetic resonance angiography showed occlusion of the left ICA distal to a PPTA. We performed mechanical thrombectomy (MT) using a combined technique with a balloon guide catheter (BGC), aspiration catheter, and stent retriever and achieved complete recanalization without ENT. The patient experienced a good postoperative recovery course. At 6 months, her Modified Rankin Scale score was 2. CONCLUSION: MT using a combined technique with BGC would be useful to prevent embolization to the posterior circulation through the PPTA in cases of ICA occlusion with PPTA.