The persistent trigeminal artery is recognized as the most prevalent of the persistent embryonic carotid-basilar anastomoses. During early embryonic development, this artery serves as a crucial connection between the internal carotid and basilar arteries. Typically, it regresses as other, more permanent connections develop.  However, in some individuals, it persists into adulthood. Though often an incidental finding on imaging studies, the PTA's presence can have profound clinical consequences, underscoring the need for awareness and recognition among healthcare professionals.

The PTA typically originates from the internal carotid artery and extends to join the basilar artery, often in close proximity to the trigeminal nerve. This anatomical positioning can lead to diagnostic challenges, as the PTA may resemble other vascular structures or variants. 

As part of our methodology, we also reviewed a selection of case studies that highlighted patients with a persistent trigeminal artery and associated vascular anomalies. These case studies provided valuable insights into the clinical presentation of patients, as well as the imaging findings that led to the identification of the PTA. We documented not only the imaging characteristics but also any clinical symptoms these patients experienced, such as trigeminal neuralgia or symptoms related to vascular compression.

By synthesizing the data from literature and our clinical practice, we aimed to develop a more thorough understanding of the persistent trigeminal artery and encourage vigilance in its recognition during imaging studies. This comprehensive evaluation serves to enhance the diagnostic acumen of radiologists and to underscore the importance of considering the PTA in various clinical contexts.