Poor Collateral Circulation Assessed by Multiphase Computed Tomographic Angiography Predicts Malignant Middle Cerebral Artery Evolution After Reperfusion Therapies

Abstract Background Dynamic axial computed tomographic angiography (dynax–CTA), covering a thin width, with a focus on the bilateral middle cerebral artery (MCA), can quickly visualize the internal carotid artery (ICA) or MCA occlusion. We aimed to investigate whether dynax–CTA appropriately evaluated the collateral status coupled with the upper limit of the onset-to-reperfusion (OtR) time to achieve a major neurological improvement (MNI) at a 24-h follow-up examination after mechanical thrombectomy (MT). Methods We included acute ischemic stroke patients admitted from 2018 to 2020 who underwent dynax–CTA on admission and emergent MT for ICA or MCA occlusion. We performed dynax–CTA using an 80-row CT scanner and acquired 25 volume scans, consisting of 40 images of 1-mm thickness and 4-cm width. We classified the collateral status as good, intermediate, and poor based on MCA branch opacification. We evaluated the collateral status and the upper OtR time limit to achieve MNI. Results Forty-eight patients met our inclusion criteria. Dynax–CTA findings demonstrated MCA and ICA occlusion in 30 and 18 patients, respectively. The collateral status was good, intermediate, and poor in four, 25, and 19 patients, respectively. The upper limits of the OtR time for MNI were 3.63, 8.08, and 8.67 h in patients with poor, intermediate, and intermediate or good collateral status, respectively. Conclusions Dynax–CTA appropriately evaluated the collateral status coupled with the upper limit of the OtR time before performing MT.

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A New, More Accurate Classification of Middle Cerebral Artery Aneurysms

Neurosurgery ◽

10.1227/01.neu.0000429842.61213.d5 ◽

2013 ◽

Vol 73 (1) ◽

pp. 94-102 ◽

Cited By ~ 35

Author(s):

Ahmed Elsharkawy ◽

Martin Lehečka ◽

Mika Niemelä ◽

Romain Billon-Grand ◽

Hanna Lehto ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Computed Tomographic Angiography ◽

Group Classification ◽

Intracerebral Hematoma ◽

Computed Tomographic ◽

Common Location ◽

Lenticulostriate Artery ◽

Tomographic Angiography

Abstract BACKGROUND: Classification of middle cerebral artery (MCA) aneurysms is sometimes difficult because the identification of the main MCA bifurcation, the key for accurate classification of MCA aneurysms, is inconsistent and somewhat subjective. OBJECTIVE: To use the meeting point of the M1 and M2 trunks as an objective, generally accepted, and angiographically evident hallmark for identification of MCA bifurcation and more accurate classification of MCA aneurysms. METHODS: We reviewed the computed tomographic angiography data of 1009 consecutive patients with 1309 MCA aneurysms. The M2 trunks were followed proximally until their meeting with the M1 trunk at the main MCA bifurcation. The aneurysms were classified according to their relative location: proximal, at, or distal to the MCA bifurcation. The M1 aneurysms were further subgrouped into M1 early cortical branch aneurysms and M1 lenticulostriate artery aneurysms, extending the classic 3-group classification of MCA aneurysms into a 4-group classification. RESULTS: The main MCA bifurcation was the most common location for MCA aneurysms, harboring 829 aneurysms (63%). The 406 M1 aneurysms comprised 242 M1 early cortical branch aneurysms (60%) and 164 M1 lenticulostriate artery aneurysms (40%). We found 106 MCA aneurysms (8%) at the origin of large early frontal branches simulating M2 trunks liable to be misclassified as MCA bifurcation aneurysms. Even though 51% of the 407 ruptured MCA aneurysms were associated with an intracerebral hematoma, this did not affect the classification. CONCLUSION: Studying MCA angioarchitecture and applying the 4-group classification of MCA aneurysms is practical and facilitates the accurate classification of MCA aneurysms, helping to improve surgical outcome.

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Rare case of a ruptured distal middle cerebral artery fusiform aneurysm: a neurosurgical challenge.

International Journal Of Medical Science And Clinical Invention ◽

10.18535/ijmsci/v5i2.12 ◽

2018 ◽

Vol 5 (2) ◽

pp. 3550-3552

Author(s):

Jagminder Singh ◽

Amit Mittal ◽

Rakesh Kumar Kaushal ◽

Rupinder Kaur ◽

Simran Kaur ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Surgical Intervention ◽

Computed Tomographic Angiography ◽

Fusiform Aneurysm ◽

Computed Tomographic ◽

Tomographic Angiography ◽

Middle Cerebral Artery Aneurysms ◽

Distal Middle Cerebral Artery ◽

Early Surgical Intervention

Distal ruptured fusiform middle cerebral artery (MCA) M4 segment aneurysms are rare and their management is a challenge to the neurosurgeon. Fusiform aneurysm of M4 part of is even rarer. Patient usually presents with headache or neurological deficit. Computed tomographic angiography helps to confirm diagnosis. Treatment involves micro-neurosurgical clipping or trapping and excision of aneurysm. Early surgical intervention of distal middle cerebral artery aneurysms favours better outcome. We report a case of 20 year old female patient who presented with complaint of severe headache. Neuroimaging was suggestive of right M4 middle cerebral artery fusiform aneurysm with intracerebral haemorrhage. Patient was managed by trapping and excision of aneurysm and recovered well.

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