{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T13:35:05Z","timestamp":1780925705769,"version":"3.54.1"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,2,4]],"date-time":"2025-02-04T00:00:00Z","timestamp":1738627200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:p>The proatlantal intersegmental artery (PIA) plays a crucial role in blood supply during embryonic development, and failure of its closure can lead to the persistent proatlantal intersegmental artery (PPIA), which may result in pathological changes such as dissection and aneurysms. We present a case of a patient with right type II PPIA dissection inducing an embolic shower, accompanied by left vertebral artery hypoplasia (VAH). Digital subtraction angiography (DSA) and high-resolution magnetic resonance vascular wall imaging (HRMR-VWI) showed the aneurysmal dilation of the false lumen in the right PPIA dissection and indicated the high risk of mural thrombosis and dislodgement. Following a comprehensive evaluation of the patient\u2019s condition, we conducted pipeline embolization device (PED)-assisted angioplasty to treat the PPIA dissection and mitigate the risk of recurrent strokes. Postoperative follow-up indicated that the patient recovered smoothly, with no signs of recurrent stroke. This case highlights the critical need for prompt recognition and intervention in cases of rare vascular variants. The flow diverter implantation can greatly enhance patient outcomes and lower the risk of recurrent strokes, offering important insights for the clinical management of similar cases. Additional research is necessary to investigate the underlying pathological mechanisms of PPIA and its connection to stroke occurrence, which will help refine treatment strategies in the future.<\/jats:p>","DOI":"10.3389\/fneur.2025.1490799","type":"journal-article","created":{"date-parts":[[2025,2,4]],"date-time":"2025-02-04T05:28:56Z","timestamp":1738646936000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Pipeline embolization device-assisted angioplasty for type II proatlantal intersegmental artery dissection inducing an embolic shower"],"prefix":"10.3389","volume":"16","author":[{"given":"Li","family":"Bao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenguo","family":"Pan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haifeng","family":"Ji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuang","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,2,4]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1007\/s00381-008-0765-7","article-title":"Proatlantal intersegmental artery: a review of normal and pathological features","volume":"25","author":"Vasovi\u0107","year":"2009","journal-title":"Childs Nerv Syst"},{"key":"ref2","first-page":"2378","article-title":"Proatlantal intersegmental arteries of external carotid artery origin associated with Galen\u2019s vein malformation","volume":"26","author":"Purkayastha","year":"2005","journal-title":"AJNR Am J Neuroradiol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1427","DOI":"10.2214\/ajr.172.5.10227532","article-title":"The persistent fetal carotid-vertebrobasilar anastomoses","volume":"172","author":"Luh","year":"1999","journal-title":"AJR Am J Roentgenol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1027","DOI":"10.1148\/rg.294085730","article-title":"Normal variants of the cerebral circulation at multidetector CT angiography","volume":"29","author":"Dimmick","year":"2009","journal-title":"Radiographics"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1016\/j.diii.2015.11.002","article-title":"A symptomatic presentation of a rare type of proatlantal artery","volume":"97","author":"Dimitriade","year":"2016","journal-title":"Diagn Interv Imaging"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1080\/08998280.2013.11928918","article-title":"Persistent bilateral proatlantal type II artery","volume":"26","author":"Zarghouni","year":"2013","journal-title":"Proc (Bayl Univ Med Cent)"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1002\/ca.980080107","article-title":"Primitive persistent carotid\u2010basilar and carotid\u2010vertebral anastomoses: a report of seven gases and a review of the literature","volume":"8","author":"Yilmaz","year":"1995","journal-title":"J Neurosurg"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1002\/ar.1091190306","article-title":"Designation of the embryonic intersegmental arteries in reference to the vertebral artery and subclavian stem","volume":"119","author":"Padget","year":"1954","journal-title":"Anat Rec"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e481","DOI":"10.1161\/strokeaha.122.040239","article-title":"Whole-brain perfusion via right common carotid artery with type 2 proatlantal intersegmental artery","volume":"53","author":"Zuflacht","year":"2022","journal-title":"Stroke"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"2114","DOI":"10.1161\/01.str.24.12.2114","article-title":"Persistent primitive proatlantal intersegmental artery (proatlantal artery I) results in \u2018top of the basilar\u2019 syndrome","volume":"24","author":"Bah\u015fi","year":"1993","journal-title":"Stroke"},{"key":"ref11","first-page":"976","article-title":"A case of pontine infarction with persistent primitive proatlantal artery","volume":"33","author":"Ikeda","year":"1993","journal-title":"Rinsho Shinkeigaku"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"458","DOI":"10.1159\/000101748","article-title":"Carotid endarterectomy in a patient with persistent proatlantal artery","volume":"23","author":"Schoof","year":"2007","journal-title":"Cerebrovasc Dis"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1671","DOI":"10.1007\/s13760-024-02538-5","article-title":"Unusual vascular cause of syncope in an adult patient: type 2 proatlantal intersegmental artery","volume":"124","author":"Gocer","year":"2024","journal-title":"Acta Neurol Belg"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"807","DOI":"10.1016\/j.jvs.2014.10.100","article-title":"Occurrence of a type 2 proatlantal intersegmental artery during carotid endarterectomy for symptomatic stenosis","volume":"64","author":"Liechty","year":"2016","journal-title":"J Vasc Surg"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1016\/0022-510x(93)90178-2","article-title":"Right proatlantal artery type I, right internal carotid occlusion, and left internal carotid stenosis: case report and review of the literature","volume":"117","author":"Kolbinger","year":"1993","journal-title":"J Neurol Sci"},{"key":"ref16","first-page":"775","article-title":"A case of a persistent primitive proatlantal intersegmental artery with a ruptured basilar bifurcation aneurysm","volume":"29","author":"Nonaka","year":"2001","journal-title":"No Shinkei Geka"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"710","DOI":"10.3760\/cma.j.issn.1006-7876.2019.09.003","article-title":"Diagnostic criteria of cerebrovascular diseases in China","volume":"52","year":"2019","journal-title":"Chin J Neurol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"812458","DOI":"10.3389\/fneur.2022.812458","article-title":"Case report: Stent retriever thrombectomy of acute basilar artery occlusion via the type 1 proatlantal intersegmental artery","volume":"13","author":"Zhao","year":"2022","journal-title":"Front Neurol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"e47724","DOI":"10.7759\/cureus.47724","article-title":"Intracranial angioplasty via type II proatlantal intersegmental artery","volume":"15","author":"Babici","year":"2023","journal-title":"Cureus"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1154","DOI":"10.1080\/02688697.2020.1850639","article-title":"Reflux compensation of persistent proatlantal intersegmental artery: report of one case","volume":"37","author":"Haiqi","year":"2023","journal-title":"Br J Neurosurg"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1490799\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,4]],"date-time":"2025-02-04T05:29:00Z","timestamp":1738646940000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1490799\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,4]]},"references-count":20,"alternative-id":["10.3389\/fneur.2025.1490799"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2025.1490799","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,4]]},"article-number":"1490799"}}