Anatomical variants of anterior communicating artery complex. A study by Computerized Tomographic Angiography

Background: The subcallosal artery (ScA) is a single dominant artery arising from the anterior communicating artery. Its injury causes amnesia and cognitive disturbance. The conventional computed tomographic angiography (C-CTA) is a common evaluation method of the intracranial artery. However, to image tinny perforating arteries such as the ScA is technically demanding for C-CTA. The purpose of this study is to investigate whether the ultra-high-resolution CTA (UHR-CTA) could image the ScA better than C-CTA. UHR-CTA became available in clinical practice in 2017. Its novel features are the improvement of the detector system and a small X-ray focus. Methods: Between April 2019 and May 2020, 77 and 49 patients who underwent intracranial UHR-CTA and C-CTA, respectively, were enrolled in this study. Two board-certified neurosurgeons participated as observers to identify the ScA based on UHR-CTA and C-CTA images. Results: UHR-CTA and C-CTA detected the ScA in 56–58% and 30–40% of the patients, respectively. In visualization of the ScA, UHR-CTA was better than C-CTA (P < 0.05, Fisher’s exact test). Between the two observers, the Cohen’s kappa coefficient was 0.77 for UHR-CTA and 0.78 for C-CTA. Conclusions: UHR-CTA is a simple and accessible method to evaluate intracranial vasculature. Visualization of the ScA with UHR-CTA was better than that with C-CTA. The high quality of UHR-CTA could provide useful information in the neurosurgery field.

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Anatomical Variants of Anterior Cerebral Arterial Circle: A Study by Multidetector Computerized 3D Tomographic Angiography

International Journal of Morphology ◽

10.4067/s0717-95022017000300049 ◽

2017 ◽

Vol 35 (3) ◽

pp. 1121-1128 ◽

Cited By ~ 1

Author(s):

Michelle Stephanie Jiménez-Sosa ◽

Juan Ramón Cantu-Gonzalez ◽

Rodolfo Morales-Avalos ◽

Oscar de la Garza-Castro ◽

Alejandro Quiroga-Garza ◽

...

Keyword(s):

Anatomical Variants ◽

Tomographic Angiography

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Paraplegia Due to Rupture of an Anterior Communicating Artery Aneurysm

Interventional Neuroradiology ◽

10.1177/159101999600200107 ◽

1996 ◽

Vol 2 (1) ◽

pp. 53-57

Author(s):

T. Kombos ◽

H.-J. Meisel ◽

C. Janz ◽

M. Brock

Keyword(s):

Cerebral Angiography ◽

Artery Aneurysm ◽

Anterior Communicating Artery ◽

Anatomical Variants ◽

Anterior Communicating Artery Aneurysm ◽

Spinal Lesion

A 44-year-old patient developed paraplegia following rupture of an anterior communicating artery aneurysm. There was no evidence of any spinal lesion. Cerebral angiography showed a paired bihemispheric disposition of the A2 segment. We report this case and consider the anatomical variants of the A2 segment described in literature. The paired bihemispheric variant was reported in 21% of the cases. An azygos (unpaired) artery was observed in 5% and a triplicated A2 segment in 20% of the cases.

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Carotid siphon geometry and variants of the circle of Willis in the origin of carotid aneurysms

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2012001200003 ◽

2012 ◽

Vol 70 (12) ◽

pp. 917-921 ◽

Cited By ~ 10

Author(s):

Ângelo Raimundo Silva Neto ◽

Ródio Luis Brandão Câmara ◽

Marcelo Moraes Valença

Keyword(s):

Retrospective Analysis ◽

Circle Of Willis ◽

Posterior Communicating Artery ◽

Control Group ◽

Anterior Communicating Artery ◽

Anatomical Variants ◽

Carotid Siphon ◽

Hemodynamic Stress ◽

Carotid Aneurysms

This study evaluated anatomical variants in the carotid siphon and of the circle of Willis in patients with aneurysms. We performed a retrospective analysis of cerebral angiographies. The Control Group was composed of patients without aneurysms. Posterior communicating artery (PcomA) aneurysms were more common in women (p<0.05), and the anterior communicating artery (AcomA) aneurysms in men (p<0.1). The incidence of fetal-type PcomA was higher in cases with co-occurring PcomA aneurysm (24 versus 8%, p<0.05). Patients with AcomA aneurysm had higher incidence of A1 hypoplasia (p<0.0001, OR=32.13, 95%CI 12.95-79.71) and lower frequency of fetal-type PcomA compared to their control counterparts (p=0.0125). The angle of carotid siphon was narrower in patients with PcomA aneurysm (27.3±19.1 versus 34.8±22.6, p=0.028). In conclusion, a narrower carotid siphon or the presence of fetal-type PcomA or A1 hypoplasia may cause hemodynamic stress, thereby promoting the formation of aneurysms in susceptible individuals.

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Angles between A1 and A2 Segments of the Anterior Cerebral Artery Visualized by Three-dimensional Computed Tomographic Angiography and Association of Anterior Communicating Artery Aneurysms

Neurosurgery ◽

10.1227/00006123-199907000-00021 ◽

1999 ◽

Vol 45 (1) ◽

pp. 89 ◽

Cited By ~ 2

Author(s):

Hidetoshi Kasuya ◽

Takashi Shimizu ◽

Kotaro Nakaya ◽

Atsushi Sasahara ◽

Tomokatsu Hori ◽

...

Keyword(s):

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Three Dimensional ◽

Computed Tomographic Angiography ◽

Anterior Communicating Artery ◽

Computed Tomographic ◽

Anterior Communicating Artery Aneurysms ◽

Tomographic Angiography

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Abstract 1122‐000184: Cerebral Arterial Variations in Patients with Ischemic Stroke Undergoing Mechanical Thrombectomy

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000184 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Bernard Solewski ◽

Karolina Brzegowy ◽

Paweł Brzegowy ◽

Agata Musiał ◽

Tadeusz Popiela ◽

...

Keyword(s):

Ischemic Stroke ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Mechanical Thrombectomy ◽

Anterior Communicating Artery ◽

Adult Type ◽

Anterior Portion ◽

Posterior Portion ◽

Anatomical Variants ◽

Retrospective Assessment

Introduction : This study aimed to determine what anatomical variants of the Circle of Willis (CoW) and the middle cerebral artery(MCA) are observed in patients with acute M1 occlusion and whether their prevalence differs from that described as “normal” in anatomy textbooks. Methods : We have performed a retrospective assessment of radiological examinations of patients with stroke due to middle cerebral artery M1 segment occlusion. All patients underwent mechanical thrombectomy from January 2015 until March 2021. The anatomy of the CoW was assessed on initial CT‐angiography and DSA. Branches of the MCA were observed on control DSA after recanalization. Results : A total of 100 patients were included in the analysis (58 females and 42 males, mean age: 71.6 +/‐ 13.9). Fully complete CoW was observed in 19% of patients. A total of 10% of patients had an incomplete anterior portion of CoW. In the incomplete anterior portion subgroup, the most common variation was the absence of anterior communicating artery (6% of total hemispheres), followed by the absence of one A1 (3% of total hemispheres). An incomplete posterior portion of CoW was identified in 79% of the patients. The absence of posterior communicating artery (PCoA) was observed in 59 patients. Sixteen patients had adult‐type PCoA, 3 patients had transitional‐type PCoA and 21 patients had fetal‐type posterior cerebral artery (PCA). In the subgroup of patients with fetal‐type posterior circle, 5 patients had no P1 segment of PCA. Anterior temporal branch of MCA was observed in 45% of the patients. Middle cerebral artery bifurcation was found in 80% of hemispheres, and trifurcation in 20%. In the bifurcation subgroup, 26% of MCAs had a dominating upper branch and 18% had a dominating lower branch. A duplicate MCA was observed in one hemisphere. Conclusions : In comparison to normal anatomy described in anatomy textbooks, the population of patients suffering from ischemic stroke due to M1 occlusion had a lower proportion of complete and closed CoW. A foetal type PCoA was observed to be prevalent (21%) in patients suffering from acute M1 occlusion. Detailed anatomical knowledge of anatomical variants of CoW in patients undergoing mechanical thrombectomy is essential for clinicians performing intravascular interventions and may aid procedure planning.

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Anomalous left anterior cerebral artery with hypoplastic right anterior cerebral artery

Anatomy Journal of Africa ◽

10.4314/aja.v7i1.169480 ◽

2018 ◽

Vol 7 (1) ◽

pp. 1138-1140

Author(s):

A Mahajan ◽

G Goel ◽

B Das

Keyword(s):

Computed Tomography ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Cerebral Artery ◽

Internal Carotid ◽

Anterior Cerebral Artery ◽

Computed Tomographic Angiography ◽

Anterior Communicating Artery ◽

Computed Tomographic ◽

Tomographic Angiography

We report an extremely rare anomalous variation of left anterior cerebral artery arising from the contralateral Paraclinoid Internal carotid artery with Hypoplastic right Anterior cerebral artery in a 56 years old female which was incidentally detected on computed tomographic angiography of cerebral vessels. Angiographic identification and characterisation of this anomaly is very important in developing a differential diagnosis and when planning a surgery and endovascular procedure.Keywords: Anterior cerebral artery, Paraclinoid Internal carotid artery, Anterior communicating artery Computed tomography angiography

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BLISTER-LIKE ANEURYSMS OF THE ANTERIOR COMMUNICATING ARTERY

Neurosurgery ◽

10.1227/01.neu.0000318164.44601.09 ◽

2008 ◽

Vol 62 (4) ◽

pp. 807-811 ◽

Cited By ~ 36

Author(s):

Norberto Andaluz ◽

Mario Zuccarello

Keyword(s):

Subarachnoid Hemorrhage ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Digital Subtraction Angiography ◽

Internal Carotid ◽

Computed Tomographic Angiography ◽

Anterior Communicating Artery ◽

Digital Subtraction ◽

Computed Tomographic ◽

Tomographic Angiography

Abstract OBJECTIVE Blood blister-like aneurysms are small hemispherical bulges from the dorsomedial wall of the internal carotid artery that resemble berry aneurysms but differ in their clinical and surgical features. On the basis of our literature review, blister-like aneurysms have been reported to occur only at nonbranching sites of the dorsomedial internal carotid artery. In this report on our series of five patients, we describe blister-like aneurysms of the anterior communicating artery (AComA) and discuss important diagnostic and therapeutic aspects unique to them. METHODS In our retrospective review of 719 patients with nontraumatic subarachnoid hemorrhage admitted to our service from 1998 to 2003, 181 (25.17%) patients harbored AComA aneurysms. Five (2.76%) patients (four women, one man) had blister-like aneurysms that were recognized at the time of surgery. RESULTS Initial digital subtraction angiography was diagnostic in only one patient. A second digital subtraction angiogram was diagnostic in one patient but failed to reveal an aneurysm in the remaining three patients; these were eventually diagnosed by computed tomographic angiography. All aneurysms were clipped. At the time of surgery, the aneurysms arose from the horizontal portion of the AComA without any involvement of the branches of the anterior cerebral artery. All presented as blister-like aneurysms that were thin-walled and lacking a surgical neck. On dissection, two of the lesions ruptured. All lesions were treated with straight fenestrated clips through the A1–AComA junction, thus remodeling the AComA. No delayed rupture was noted at the time of the last follow-up evaluation. At the time of discharge, outcomes were good in two patients, fair in two, and poor in the remaining patient. CONCLUSION Blister-like aneurysms constitute technically challenging lesions that may occur at the AComA. Computed tomographic angiography is valuable in diagnosis. Blister-like aneurysms should be suspected when digital subtraction angiography findings are negative for subarachnoid hemorrhage.

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