title: Classification of persistent primitive trigeminal artery (PPTA): a reconsideration based on MRA.
abstract: BACKGROUND
  Persistent primitive trigeminal artery (PPTA) is the most common permanent carotid-basilar anastomosis. Magnetic resonance angiography (MRA) has become the primary non-invasive imaging technique for evaluation of cerebral vascular anatomy and can provide detailed 3D imaging of intracranial vessels.
  
  
  OBJECTIVE
  To evaluate the usefulness of MRA for the detection of PPTA and to re-classify its variations based on the embryologic types of PcomA and its relationship with the basilar artery and its branches.
  
  
  METHODS
  Of the total 7329 patients who underwent MRA at our institution from March 2008 through November 2010, we retrospectively analyzed the MRAs of 24 patients with a PPTA. Special attention was given to defining the relationship of the PPTA and the basilar artery with PcomA and to determine the site of origin, size, and course of the PPTA. The PPTA classification included five types based on their anatomic relationship to the neighboring arteries. Clinical features and associated vascular anomalies are also described.
  
  
  RESULTS
  Twenty-four (17 women and seven men, 34 ~ 81 years of age, mean age 59.67 years) of the 7329 patients had a PPTA (0.33 %). Eleven cases (45.8%) were classified as type 1, three (12.5%) as type 2, five (20.8%) as type 3, one (4.2%) as type 4, and four (16.7%) as type 5b. Fifteen PPTAs (62.5%) were located on the left side and nine were located (37.5%) on the right side. The basilar artery proximal to the insertion of the PPTA showed severe to moderate hypoplasia in 13 cases (54%). Nine intracranial artery aneurysms were detected in seven (29%) of the 24 study patients.
  
  
  CONCLUSIONS
  This study revealed five types of PPTA and necessitates an adjustment of the previous classification of PPTA on the basis of our MRA examinations. A PPTA should be considered by both the clinician and the radiologist who interpret MR angiography.
authors.affiliation: Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan,  Korea.
authors.forename: Young Cheol
authors.initials: YC
authors.lastname: Weon
authors.forename: Seong Hoon
authors.initials: SH
authors.lastname: Choi
authors.forename: Jae Cheol
authors.initials: JC
authors.lastname: Hwang
authors.forename: Shang Hun
authors.initials: SH
authors.lastname: Shin
authors.forename: Woon-Jung
authors.initials: WJ
authors.lastname: Kwon
authors.forename: Byeong Seong
authors.initials: BS
authors.lastname: Kang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002536:Cerebral Arteries / Q000002:abnormalities* / Q000196:embryology / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D002532:Intracranial Aneurysm / Q000175:diagnosis; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012737:Sex Factors