Objective: A persistent trigeminal artery (PTA) may be found incidentally on conventional cerebral angiography and magnetic resonance(MR) angiography. Our goal is to examine the course and relationships of the vessel to the surrounding structures. Methods: Cerebral angiography was performed in 494 patients and MRA in 880; the patients had or were suspected to have cerebrovascular disease. In the images, the incidence, origin, course, and relationships of the PTA were evaluated. Results: A PTA was found in two (0.4%) of the patients undergoing cerebral angiography and three (0.34%) receiving an MR angiography. In four patients, the PTA arose from the lateral part of the cavernous segment of the internal carotid artery, then passed caudally and around the base of the dorsum sellae. In the other patient, the PTA arose from the medial aspect of the siphon, and ascended sharply to pierce the dorsum sellae and join the basilar artery. In four cases, there was hypoplasia of a proximal basilar artery below the abnormal communication; the vessel was of increased diameter above the communication. Conclusion: Identification of a PTA with a trans-sellar course is crucial if trans-sphenoidal surgery is planned. Hypoplasia of a proximal basilar artery should not be mistaken for an acquired narrowing.