Computed tomography angiography in detection and characterization of ruptured anterior cerebral artery aneurysms at uncommon location for emergent surgical clipping

2006 ◽  
Vol 30 (2) ◽  
pp. 87-93 ◽  
Author(s):  
Chia-yuen Chen ◽  
Shu-Chiang Hsieh ◽  
Wai-Man Choi ◽  
Pei-yeh Chiang ◽  
Jerry Chin-Wei Chien ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cerebral Artery ◽  
Computed Tomography Angiography ◽  
Anterior Cerebral Artery ◽  
Surgical Clipping ◽  
Uncommon Location

scholarly journals Angiographic Pitfall: Duplicated Tapered A1 Segment of the Anterior Cerebral Artery Mimicking an Anterior Communicating Artery Aneurysm

2011 ◽  
Vol 17 (2) ◽  
pp. 179-182 ◽  
Author(s):  
A.G. Weil ◽  
M.W. Bojanowski ◽  
F. Scholtes ◽  
T.E. Darsaut ◽  
F. Signorelli ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cerebral Artery ◽  
Computed Tomography Angiography ◽  
Anterior Cerebral Artery ◽  
Surgical Intervention ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Conventional Angiography ◽  
Hemodynamic Stress ◽  
Partially Occluded

We describe a misleading case of a partially occluded A1 segment duplication that mimicked an ACoA aneurysm on computed tomography angiography and conventional angiography and led to surgical intervention. The location of such an anomaly at the ACoA on the side of least hemodynamic stress may provide a clue to recognizing this variant.

scholarly journals Serial Quantitative Computed Tomography Perfusion in Aneurysmal Subarachnoid Hemorrhage

2016 ◽  
Vol 43 (3) ◽  
pp. 375-380 ◽  
Author(s):  
Cheemun Lum ◽  
Matthew J. Hogan ◽  
John Sinclair ◽  
Shane English ◽  
Howard Lesiuk ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Subarachnoid Hemorrhage ◽  
Middle Cerebral Artery ◽  
Transit Time ◽  
Cerebral Artery ◽  
Computed Tomography Angiography ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Mean Transit Time ◽  
Arterial Diameter ◽  
Computed Tomography Perfusion

AbstractPurpose: Computed tomography perfusion (CTP) has been performed to predict which patients with aneurysmal subarachnoid hemorrhage are at risk of developing delayed cerebral ischemia (DCI). Patients with severe arterial narrowing may have significant reduction in perfusion. However, many patients have less severe arterial narrowing. There is a paucity of literature evaluating perfusion changes which occur with mild to moderate narrowing. The purpose of our study was to investigate serial whole-brain CTP/computed tomography angiography in aneurysm-related subarachnoid hemorrhage (aSAH) patients with mild to moderate angiographic narrowing. Methods: We retrospectively studied 18 aSAH patients who had baseline and follow-up whole-brain CTP/computed tomography angiography. Thirty-one regions of interest/hemisphere at six levels were grouped by vascular territory. Arterial diameters were measured at the circle of Willis. The correlation between arterial diameter and change in CTP values, change in CTP in with and without DCI, and response to intra-arterial vasodilator therapy in DCI patients was evaluated. Results: There was correlation among the overall average cerebral blood flow (CBF; R=0.49, p<0.04), mean transit time (R=–0.48, p=0.04), and angiographic narrowing. In individual arterial territories, there was correlation between changes in CBF and arterial diameter in the middle cerebral artery (R=0.53, p=0.03), posterior cerebral artery (R=0.5, p=0.03), and anterior cerebral artery (R=0.54, p=0.02) territories. Prolonged mean transit time was correlated with arterial diameter narrowing in the middle cerebral artery territory (R=0.52, p=0.03). Patients with DCI tended to have serial worsening of CBF compared with those without DCI (p=0.055). Conclusions: Our preliminary study demonstrates there is a correlation between mild to moderate angiographic narrowing and serial changes in perfusion in patients with aSAH. Patients developing DCI tended to have progressively worsening CBF compared with those not developing DCI.

Characterization of AT2 angiotensin II receptors in rat anterior cerebral arteries

1991 ◽  
Vol 261 (3) ◽  
pp. H667-H670 ◽  
Author(s):  
K. Tsutsumi ◽  
J. M. Saavedra
Keyword(s):  
Angiotensin Ii ◽  
Cerebral Artery ◽  
Arterial Wall ◽  
Anterior Cerebral Artery ◽  
Cerebral Arteries ◽  
Male Rat ◽  
At1 Antagonist ◽  
Maximum Inhibition ◽  
Old Rats

Quantitative autoradiography using the agonist 125I-Sar1-angiotensin II was used to localize and characterize angiotensin II (AT) receptors in the anterior cerebral artery of the male rat. This artery showed a moderately high number of AT receptors, localized throughout the arterial wall. The number of receptors was higher (125 +/- 7 fmol/mg protein) in arteries from young 2-wk-old rats compared with those in adult 8-wk-old rats (43 +/- 2 fmol/mg protein). In the anterior cerebral artery, AT binding was insensitive to displacement with the selective AT1 antagonist DuP 753 but was readily displaced by the selective AT2 antagonist CGP-42112 A (concentration eliciting 50% of maximum inhibition: 6 +/- 1 x 10(-10) M). This indicated that the AT receptors in the cerebral artery were of the AT2 subtype. Our observations suggest that AT may exert its effects on cerebral circulation by stimulation of AT2 receptors and that these receptors may play a role during cerebrovascular development.

Detection of cerebral artery fenestrations by computed tomography angiography

2012 ◽  
Vol 46 (3) ◽  
pp. 239-244 ◽  
Author(s):  
Paweł Bożek ◽  
Joanna Pilch-Kowalczyk ◽  
Ewa Kluczewska ◽  
Anna Zymon-Zagórska
Keyword(s):  
Computed Tomography ◽  
Cerebral Artery ◽  
Computed Tomography Angiography

Surgical Treatment of a Large Fusiform Distal Anterior Cerebral Artery Aneurysm With In Situ End-to-Side A3—A3 Bypass Graft and Aneurysm Trapping

Neurosurgery ◽  
2011 ◽  
Vol 68 (2) ◽  
pp. E587-E591 ◽  
Author(s):  
Gavin P. Dunn ◽  
Jason L. Gerrard ◽  
David H. Jho ◽  
Christopher S. Ogilvy
Keyword(s):  
Computed Tomography ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Bypass Graft ◽  
The Body ◽  
Parent Artery ◽  
Vessel Flow ◽  
Distal Anterior Cerebral Artery ◽  
Distal Vessel

Abstract BACKGROUND AND IMPORTANCE: Large fusiform aneurysms of the distal anterior cerebral territory are extremely rare and can be particularly challenging to treat. The circumferential pathology of fusiform lesions renders stand-alone clip or coil ablation unsatisfactory, and the deep, narrow corridor augments the difficulty of surgical approaches. In this setting, bypass procedures may be used to both treat the aneurysm definitively and preserve distal parent artery flow. We report a rare case of a large fusiform A3 aneurysm treated with trapping and concomitant end-to-side A3:A3 bypass. CLINICAL PRESENTATION: A 52-year-old man was evaluated after losing consciousness and experiencing a fall. A noncontrast computed tomography scan revealed a focal area of hemorrhage above the body of the corpus callosum, and computed tomography angiography showed a fusiform aneurysm of the right A3 artery. To treat the aneurysm definitively and preserve distal vessel flow, the patient was taken to surgery in anticipation of aneurysm ablation and cerebrovascular bypass. A large, fusiform right A3 aneurysm was identified. Intraoperative flow measurement demonstrated poor collateral circulation. The aneurysm was trapped with clips, and a right-to-left A3:A3 end-to-side in situ bypass was performed. Aneurysm occlusion and preserved distal vessel flow were confirmed with intraoperative angiography. CONCLUSION: Large fusiform aneurysms in the distal anterior cerebral artery region are rare, and the anatomy of these lesions and their vascular location render stand-alone surgical management technically challenging. End-to-side A3:A3 bypass combined with aneurysm trapping represents a feasible treatment strategy for lesions in this location.

Interrater Agreement in the Radiologic Characterization of Ruptured Intracranial Aneurysms Based on Computed Tomography Angiography

2017 ◽  
Vol 103 ◽  
pp. 876-882.e1 ◽  
Author(s):  
Nicolai Maldaner ◽  
Martin N. Stienen ◽  
Philippe Bijlenga ◽  
Davide Croci ◽  
Daniel W. Zumofen ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Computed Tomography Angiography ◽  
Intracranial Aneurysms ◽  
Interrater Agreement ◽  
Ruptured Intracranial Aneurysms

Anatomic Risk Factors for Middle Cerebral Artery Aneurysm Rupture

Neurosurgery ◽  
2013 ◽  
Vol 73 (5) ◽  
pp. 825-837 ◽  
Author(s):  
Ahmed Elsharkawy ◽  
Martin Lehečka ◽  
Mika Niemelä ◽  
Juri Kivelev ◽  
Romain Billon-Grand ◽  
...  
Keyword(s):  
Risk Factors ◽  
Computed Tomography ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Computed Tomography Angiography ◽  
Artery Aneurysm ◽  
University Hospital ◽  
Width Ratio ◽  
Aneurysm Wall ◽  
Unruptured Intracranial Aneurysms

Abstract BACKGROUND: The middle cerebral artery (MCA) is the most frequent location for unruptured intracranial aneurysms. Controversy remains as to which unruptured MCA aneurysms should be treated prophylactically. OBJECTIVE: To identify independent topographical and morphological variables that could predict increased rupture risk of MCA aneurysms. METHODS: A retrospective analysis of computed tomography angiography data of 1009 consecutive patients with 1309 MCA aneurysms, referred between 2000 and 2009 to Helsinki University Hospital, was carried out. Morphological and topographical parameters examined for MCA aneurysms comprised aneurysm wall regularity, size, neck width, aspect ratio, bottleneck factor, height-width ratio, location along the MCA, side, distance from the internal carotid artery bifurcation, and dome projection in axial and coronal computed tomography angiography views. Univariate and multivariate logistic regression analyses were performed to determine independent risk factors for rupture. RESULTS: Of the 1309 MCA aneurysms, 69% were unruptured and 31% were ruptured. Most unruptured MCA aneurysms were smaller than 7 mm (78%), with a smooth wall (80%) and a height-width ratio of 1 (47%) and were located at the main bifurcation (57%). Ruptured MCA aneurysms, mostly 7 to 14 mm in size (55%), had an irregular wall (78%) and a height-width ratio greater than 1 (72%) and were located at the main bifurcation (77%). Thirty-eight percent of MCA bifurcation aneurysms, 74% of large aneurysms, 64% of aneurysms with an irregular wall, and 49% of aneurysms with a height-width ratio greater than 1 were ruptured. CONCLUSION: Location at the main MCA bifurcation, wall irregularity, and less spherical geometry were independently associated with rupture of MCA aneurysms with a correlation with aneurysm size.

scholarly journals Balloon-Assisted Cannulation for Difficult Anterior Cerebral Artery Access

2017 ◽  
Vol 7 (1-2) ◽  
pp. 48-52
Author(s):  
Varun Naragum ◽  
Mohamad AbdalKader ◽  
Thanh N. Nguyen ◽  
Alexander Norbash
Keyword(s):  
Cerebral Artery ◽  
Paradigm Shift ◽  
Intracranial Aneurysms ◽  
Anterior Cerebral Artery ◽  
Endovascular Coiling ◽  
Anterior Communicating Artery ◽  
Surgical Clipping ◽  
Ruptured Aneurysms ◽  
Common Location ◽  
Proximal Middle Cerebral Artery

The anterior communicating artery is a common location for intracranial aneurysms. Compared to surgical clipping, endovascular coiling has been shown to improve outcomes for patients with ruptured aneurysms and we have seen a paradigm shift favoring this technique for treating aneurysms. Access to the anterior cerebral artery can be challenging, especially in patients with tortuous anatomy or subarachnoid hemorrhage or in patients presenting with vasospasm. We present a technique for cannulating the anterior cerebral artery using a balloon inflated in the proximal middle cerebral artery as a rebound surface.

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