Abstract W P367: Anterior Cerebral Artery Diameter Predicts Anterior Cerebral Artery Territorial Stroke.

Background: Anterior cerebral artery strokes (ACAS) account for only 1-2% of cerebral infarctions, and typically result from embolism in western populations. The cause of the low frequency of ACAS in relation to MCA strokes (MCAS) is uncertain, but differences in arterial anatomy may affect flow-directed embolism rates. We aimed to determine whether variability in ACA A1 diameters (A1D) and A1D/MCA M1 diameter (M1D) ratios predict ACAS Methods: Consecutive patients admitted to Boston Medical Center with a diagnosis of ACAS between 01/2008-10/2012 were reviewed. Patients with an interpretable CT angiogram (CTA) or magnetic resonance angiogram (MRA) of the cerebral vasculature were eligible. Excluded were patients with ACAS ipsilateral (ipsi) to an aplastic ACA, concomitant ipsi MCAS, and those with lacunar, watershed, aneurysm clipping or local intracranial atherosclerosis as stroke etiology. Patient demographics were compiled. Ipsilateral and contralateral (contra) A1D, M1D, as well as ICA-ACA and ICA-MCA angles were measured from CTA and MRA images. Consecutive MCAS admitted between 01/2011-10/2012 served as controls. Results: The study comprised 55 individuals (27 ACA, 28 MCA) with mean age of 69 years. Stroke etiology was cardioembolism in 56%, internal carotid artery embolism in 16% and idiopathic in 27%. Patients with ACAS had larger mean ipsi A1D (2.47 vs. 2.05 mm,p<0.01), ipsi A1D/M1D ratios (0.95 vs. 0.73,p<0.001) and were more likely to have a contra aplastic/hypoplastic ACA (41 vs. 4%,<0.001). Ipsi A1D (OR per 1 mm increment: 8.52 [95% CI 1.36, 53.26]) and ipsi A1D/M1D ratio (OR per 10% increment: 1.83 [95% CI 1.15, 2.91]) remained significant following multivariate analysis. Ipsilateral M1D was protective for ACAS (OR per 1 mm increment: 0.17 [95% CI 0.03, 0.90]) after adjusting for ipsi A1D. There were no significant differences in demographic variables, stroke etiologies, terminal ICA-ACA or ICA-MCA angles between ACAS and MCAS. Conclusions: Larger ipsilateral A1D and A1D/M1D ratio are independent predictors of ACAS. These findings concur with the notion that A1D and M1D are important in determining the path of emboli that reach the terminal ICA.

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Acute isolated anterior cerebral artery infarcts: A clinical – radiological study

Neurology Asia ◽

10.54029/2021yks ◽

2021 ◽

Vol 26 (3) ◽

pp. 459-464

Author(s):

Sanjith Aaron ◽

Divyan Pancharatnam ◽

Amal Al Hashmi

Keyword(s):

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Anatomical Variations ◽

National Institutes Of Health ◽

Stroke Severity ◽

Limb Weakness ◽

Ct Angiogram ◽

The Mean ◽

Toast Classification ◽

Stroke Centre

Background: The anterior cerebral artery (ACA) supplies many eloquent areas and can have anatomical variations making ACA strokes clinically and radiologically challenging. This study looks at the clinical and radiological features of isolated acute ACA strokes from a stroke centre in Oman. Methods: A retrospective study conducted over a 2 year period on ACA strokes presenting within 12 hours of symptom onset. TOAST classification was used for aetiology. National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Scale (mRS) were used to assess stroke severity. Fischer’s classification was used for assessing the arterial segments with CT angiogram. Heidelberg Bleeding Classification was used for haemorrhagic conversion. Results: Isolated ACA strokes constituted 25/1180 (2.1 %) of ischemic strokes. Males 15/25 (60%) Mean age was 68.4 years (Range 42 -97 years). Twenty eight percent of patients had earlier strokes. Hemiparesis (68%) was the commonest clinical presentation. Twenty percent had only lower limb weakness. Hypertension 22/25 (88%) followed by diabetes mellitus 12/25 (48%) was the commonest risk factor. The mean NIHSS was 9 (range 3 to 13). In 36% of patients there was progression of stroke. Plain CT Picked the infarct only in 6/24 (25%). Left side involvement in 18/25 (72%) Artery of Hubner was involved in 6/25 (24%); 44% had an embolic aetiology. There was no mortality and at discharge, 11/25 (44%) had mRS3 or less. Conclusions: In acute ACA infarcts a CT scan can miss the diagnosis in 74%. An embolic aetiology has to be considered in any Isolated ACA stroke and the outcome appears to be good.

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Frequency and Relevance of Anterior Cerebral Artery Embolism Caused by Mechanical Thrombectomy of Middle Cerebral Artery Occlusion

American Journal of Neuroradiology ◽

10.3174/ajnr.a3462 ◽

2013 ◽

Vol 34 (8) ◽

pp. 1606-1611 ◽

Cited By ~ 39

Author(s):

W. Kurre ◽

K. Vorlaender ◽

M. Aguilar-Pérez ◽

E. Schmid ◽

H. Bäzner ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Middle Cerebral Artery Occlusion ◽

Cerebral Artery ◽

Mechanical Thrombectomy ◽

Anterior Cerebral Artery ◽

Artery Occlusion ◽

Artery Embolism ◽

Cerebral Artery Occlusion

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1679 An Unusual Case of Hypoplastic Internal Carotid Artery with Segmental Aplasia of The Anterior Cerebral Artery: A Case Report and Systematic Literature Review

British Journal of Surgery ◽

10.1093/bjs/znab259.661 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

H Whitley ◽

P Skalicky ◽

J Malik ◽

F Charvat ◽

V Benes ◽

...

Keyword(s):

Carotid Artery ◽

Literature Review ◽

Internal Carotid Artery ◽

Cerebral Artery ◽

Unusual Case ◽

Clinical Decision Making ◽

Internal Carotid ◽

Anterior Cerebral Artery ◽

Ct Angiogram ◽

The Right

Abstract Aim Hypoplasia of the internal carotid artery (ICA) is a rare morphological variant with potential implications in disease and clinical decision-making. We describe an unusual case of ICA hypoplasia in a 50-year-old female who presented with an acute episode of vertigo. CT angiogram showed an unusually short common carotid artery (CCA) on the right side, hypoplasia of the right ICA, and agenesis of the A1 segment of the right anterior cerebral artery (ACA). We provide a short review of the available literature. Method The literature review was performed according to PRISMA guidelines. Three databases (Pubmed, Web of Science, and Ovid) were searched using the terms “ICA” and “Hypoplasia”. Case reports published in English in the last 10 years were considered eligible for inclusion. Reports of acquired ICA hypoplasia or ICA agenesis were excluded. Results Our systematic literature search revealed that 19 cases of congenital ICA hypoplasia have been reported in the last 10 years. Of these, 14 were unilateral hypoplasia, including nine cases in which the anomaly was on the left, and five cases in which the anomaly was on the right. Two cases had additional aplasias; one with aplasia of the ACOM and another with aplasia of segment C6 of the ICA. Conclusions We conclude that ICA hypoplasia remains a rare anomaly, despite the increasing incidence due to the availability of imaging technology. Clinicians should be aware of these variations, as they are frequently associated with haemodynamic changes, aneurysms, and fenestrations. Such variations have important implications for planning angiographic and surgical approaches.

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Anterior cerebral artery embolism during thrombectomy increases disability and mortality

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-013793 ◽

2018 ◽

Vol 10 (11) ◽

pp. 1057-1062 ◽

Cited By ~ 15

Author(s):

Vanessa Chalumeau ◽

Raphaël Blanc ◽

Hocine Redjem ◽

Gabriele Ciccio ◽

Stanislas Smajda ◽

...

Keyword(s):

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Artery Occlusion ◽

Carotid Artery Occlusion ◽

Stent Retriever ◽

Favorable Outcome ◽

Anterior Circulation ◽

Artery Embolism ◽

Uncommon Condition ◽

Number Of Passes

ObjectiveDuring thrombectomy, thromboembolic migration in previously unaffected territory may occur and is not systematically notified. We report our data on the incidence, predictors, and clinical outcome of anterior cerebral artery emboli (ACAE).MethodsFrom a prospectively collected thrombectomy database of consecutive patients with anterior circulation stroke between January 2012 and December 2016, 690 angiographic images were analyzed to assess ACAE. The primary outcome was a favorable outcome, defined as a 3 month modified Rankin Scale score of 0–2 or equal to the pre-stroke score.ResultsACAE occurred in 65 patients (9.4%; 95% CI 7.2% to 11.6%). Internal carotid artery occlusion (tandem or terminal), Alberta Stroke Program Early CT Score <7, increasing number of passes, and use of stent retriever alone (compared with distal aspiration alone or combined with stent retriever) were found to be independent predictors of ACAE. Compared with patients without ACAE, patients with ACAE had lower rates, with an adjusted OR (95% CI) of 0.48 (0.25 to 0.92; P=0.027) for favorable outcome and 0.49 (0.25 to 0.96; P=0.038) for early neurologic improvement. ACAE was significantly associated with a higher mortality (adjusted OR 1.93; 95% CI 1.03 to 3.61; P=0.039) and intracranial hemorrhagic complications (adjusted OR 2.45; 95% CI 1.33 to 4.47; P=0.004). Despite a successful reperfusion modified Thrombolysis in Cerebral Infarction score of 2b–3 at the end of the procedure, a favorable outcome was reached in 30% of patients with ACAE compared with 52.4% in the other patients (OR 0.39; 95% CI 0.19 to 0.78; P=0.008).ConclusionsProcedural ACAE was not an uncommon condition, and was associated with increased mortality and disability rates, regardless of the success of reperfusion.

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ARTERIA ÁCIGOS CEREBRAL ANTERIOR. REPORTE DE 2 CASOS Y REVISIÓN DE LA LITERATURA. Azygos anterior cerebral artery. Report of two cases and review of the literature

Revista Argentina de Anatomía Clínica ◽

10.31051/1852.8023.v5.n2.14061 ◽

2016 ◽

Vol 5 (2) ◽

pp. 73-79

Author(s):

Antonio Calvo Rubal ◽

Fernando Martínez ◽

Osmar Telis

Keyword(s):

Cerebral Artery ◽

Cerebral Angiography ◽

Anterior Cerebral Artery ◽

Vascular Malformations ◽

Medical Center ◽

Sudden Onset ◽

Axial Tomography ◽

Excellent Outcome ◽

Arachnoid Hemorrhage ◽

Azygous Anterior Cerebral Artery

La arteria ácigos cerebral anterior (AACA) es un vaso formado por la fusión de ambas arterias pericallosas. Su presencia en series anatómicas es inferior al 5% de los casos. El objetivo de los autores es presentar dos casos de AACA asociados a un aneurisma intra-craneano y una malformación arteriovenosa (MAV). Casos clínicos: el caso 1 es una paciente de 52 años con un cuadro de hemorragia subaracnoidea. Una tomografía de cráneo (TC) confirmó el diagnóstico. Se hizo areriografía que evidenció un aneurisma de la AACA. El mismo fue clipado sin incidentes. El caso 2 se trata de un hombre que presentó un hematoma intraparenquimatoso y tenía antecedentes de haber sido operado por una malformación arteriovenosa (MAV). Una nueva arteriografía evidenció un remanente de MAV nutrido por ramos de una AACA. Se intervino sin complicaciones intraoperatorias, pero falleció en la evolución por una sepsis. La AACA es un vaso que se ve de forma transicional en embriones humanos y que se encuentra de forma reglada en mamiferos inferiors. Su presencia en cerebros adultos humanos e poco frecuente. Se destaca su asociación con aneurismas intracraneanos y alteraciones del desarrollo de la línea media cerebral. The azygos anterior cerebral artery (AACA) is a vessel formed by the fusion of both pericallosal arteries. Its presence in anatomical series is less than 5%. We present two cases of AACA, one associated with an aneurysm and other associated to an arteriovenous malformation (AVM). Clinical cases: Case 1 is a 52-year-old woman who was admitted to a hospital with sudden onset of sensory depression and headache. A cranial axial tomography (CT) demonstrated a sub-arachnoid hemorrhage. Cerebral angiography showed an aneurysm of an azygous anterior cerebral artery bifurcation. Surgical clipping was carried out with an excellent outcome. The second case is a 71-year-old man that had been operated 20 years before, of a right frontal AVM. He was admitted to a medical center with an acute severe left hemiparesis. The CT showed a right sided frontal haematoma and the cerebral angiography showed an AVM, partly fed by an AACA. The malformation was surgically treated, but the patient died at a later time as a consequence of sepsis. The AACA is seen as a transitional vessel in the human brain embryologic development, and is found in some inferior mammals and monkeys. This artery is seen in early stages related to the development of the corpus callosum. However, it disappears later on in most of the cases. Its existence in adults is infrequent, but has been reported in isolated cases sometimes associated with vascular malformations as those presented.

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