Persistent Stapedial Artery Resulting in Direct Communication between the Middle Meningeal and Basilar Arteries

Introduction: Persistent stapedial artery (PSA) is an abnormal small vessel that arises from the petrous portion of the internal carotid artery due to failure of the regression of the embryonic stapedial artery. The embryonic stapedial artery anastomoses with the ventral pharyngeal artery, which is a precursor of the external carotid artery and supplies the middle meningeal artery (MMA). The regression of the stapedial artery results in the formation of the caroticotympanic artery. Failure of this regression can result in abnormal anastomosis between the basilar artery and the middle meningeal artery. We present an angiographic image that demonstrates this rare anatomic variant.

Case Presentation: A cerebral angiogram of a 33-year-old male demonstrated the presence of a right-sided persistent stapedial artery with direct communication between the right middle meningeal and basilar arteries ([Figs. 1] and [2]).

Conclusion: Direct communication between the middle meningeal and basilar arteries is rare. Two theories exist regarding the development of such connections: the anastomosis between the basilar remnant of the trigeminal artery and the PSA; and the presence of a lateral pontine artery that develops during the embryologic life and anastomoses with the PSA. The recognition of rare anatomical variants is crucial to avoid the unintended consequences of endovascular interventions. Failure to recognize the persistent stapedial artery can result in nontarget embolization of the brainstem with devastating consequences.

Fig. 1

Fig. 2

Publication History

Article published online:
15 February 2022