scholarly journals 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

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.

Azygous Anterior Cerebral Artery Acute Occlusion Managed With Endovascular Mechanical Thrombectomy: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (4) ◽  
pp. 514-515 ◽  
Author(s):  
Leonardo Rangel-Castilla ◽  
Adnan H Siddiqui
Keyword(s):  
Cerebral Artery ◽  
Cerebral Blood Volume ◽  
Mechanical Thrombectomy ◽  
Anterior Cerebral Artery ◽  
Stent Retriever ◽  
Vessel Occlusion ◽  
Nihss Score ◽  
Acute Occlusion ◽  
Intravenous Tissue Plasminogen Activator ◽  
Azygous Anterior Cerebral Artery

Abstract Mechanical thrombectomy has become the standard of care for management of most acute large-vessel occlusion (LVO) strokes. Most intracranial occlusions are located in the middle cerebral and internal carotid arteries. We present a unique case of acute occlusion of an azygous anterior cerebral artery (ACA). A 59-yr-old man with known hypertension and alcoholism presented with right hemiparesis, right facial palsy, aphasia, and dysarthria. His initial National Institutes of Health Stroke Scale (NIHSS) score was 20. Computed tomographic angiography and perfusion imaging demonstrated acute bilateral ACA occlusion with viable penumbra and preserved cerebral blood volume. The patient was not a candidate for intravenous tissue plasminogen activator because he presented with a wake-up stroke. After consent was obtained from his family, the patient was taken urgently for endovascular recanalization. Digital subtraction angiography confirmed acute azygous ACA occlusion. Under conscious sedation, the patient underwent mechanical thrombectomy with a stent retriever and a large-bore aspiration catheter. Successful revascularization (thrombolysis in cerebral infarction [TICI] grade 3) of the azygous ACA and both A2 arteries was obtained after 2 attempts and the use of a different stent retriever (first a 3 × 30 mm Trevo [Stryker Neurovascular, Kalamazoo, Michigan] and then a 4 × 40 mm Solitaire Platinum [Medtronic, Dublin, Ireland]). A reperfusion catheter was used during both attempts. No procedure-related complications occurred. The patient was discharged to a rehabilitation facility 3 d after the procedure with an NIHSS score of 2. In this video, we present the operative nuances of an uncommon location of LVO and its endovascular management.

E-092 azygous anterior cerebral artery aneurysms

2015 ◽  
Vol 7 (Suppl 1) ◽  
pp. A81.2-A82
Author(s):  
A Nicholson ◽  
D Cooke ◽  
M Amans ◽  
F Settecase ◽  
S Hetts ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Azygous Anterior Cerebral Artery

scholarly journals Pericallosal berry aneurysm associated with azygous anterior cerebral artery – a case report

2021 ◽  
Vol 19 (3) ◽  
pp. 259-261
Author(s):  
Berrin Erok ◽  
◽  
Nu Nu Win ◽  
Sertaç Tatar ◽  
◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Anterior Segment ◽  
Radiology Department ◽  
Rare Occurrence ◽  
History Of ◽  
Aneurysm Development ◽  
Azygous Anterior Cerebral Artery ◽  
Interventional Radiology Department

Introduction. Azygos anterior cerebral artery is a rare variant of the anterior segment of the circle of Willis caused by an unusual fusion of the normally paired A2 segments of the anterior cerebral artery (ACA). Despite its rare occurrence, it is associated with various vascular and structural cerebral abnormalities, particularly berry aneurysms. Aim. We aimed to present a case of a 41-year-old female patient who presented to our neurology department with complaints of headache. Description of the case. She had a positive paternal history of aneurysmal subarachnoid hemorrhage. Magnetic resonance angiography (MRA) of her brain revealed an azygos ACA (bifurcating into two pericallosal arteries) which was associated with a saccular aneurysm at its bifurcation point. She was referred to the interventional radiology department for preventive endovascular treatment. Conclusion. Azygos ACA carries a high risk of aneurysm development and its occlusion can potentially compromise blood supply to both cerebral hemispheres. It is therefore crucial for clinicians to be aware of its significance and to report its presence in angiographic studies.

scholarly journals Mechanical Thrombectomy of Primary Distal Anterior Cerebral Artery Occlusion: A Case Report

2019 ◽  
Vol 11 (3) ◽  
pp. 265-270 ◽  
Author(s):  
Hironori Haruyama ◽  
Junji Uno ◽  
Kenta Takahara ◽  
Yosuke Kawano ◽  
Naoki Maehara ◽  
...  
Keyword(s):  
Case Report ◽  
Cerebral Artery ◽  
Mechanical Thrombectomy ◽  
Anterior Cerebral Artery ◽  
Rare Condition ◽  
Computed Tomographic Angiography ◽  
Artery Occlusion ◽  
Sudden Onset ◽  
Neurological Deficits ◽  
Computed Tomographic

Objective: Primary anterior cerebral artery (ACA) occlusion is a rare condition and sometimes leads to significant neurological deficits. We herein report on the efficacy of mechanical thrombectomy (MT) in treating the distal ACA occlusion in a clinical setting. Case Presentation: A 76-year-old woman presented with a sudden onset of right hemiparesis. Computed tomographic angiography and perfusion imaging and subsequent analysis with RAPID software revealed acute left ACA occlusion with salvageable penumbra. The patient obtained a score of 11 on the National Institutes of Health Stroke Scale. MT was performed for occlusion of the left ACA (A4), and successful reperfusion (Thrombolysis in Cerebral Infarction score of 3) was achieved on the first attempt using a stent retriever. The patient’s recovery progressed well, and she was discharged 13 days after admission with a modified Rankin Scale score of 1. Conclusion: This case report demonstrates the clinical efficacy, safety, and favorable clinical outcome of treating a primary distal ACA occlusion with MT.

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

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Ashkan Shoamanesh ◽  
Hesham Masoud ◽  
Katrina Weed ◽  
Kaylyn Duerfeldt ◽  
Helena Lau ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Medical Center ◽  
Low Frequency ◽  
Demographic Variables ◽  
Patient Demographics ◽  
Stroke Etiology ◽  
Artery Embolism ◽  
Ct Angiogram ◽  
Arterial Anatomy

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.

scholarly journals Unruptured Saccular Aneurysm Arising from the Fenestrated A1 Segment of the Anterior Cerebral Artery: Report of 2 Cases

2018 ◽  
Vol 10 (2) ◽  
pp. 140-149 ◽  
Author(s):  
Naoya Iwabuchi ◽  
Atsushi Saito ◽  
Kentaro Fujimoto ◽  
Taigen Nakamura ◽  
Tatsuya Sasaki
Keyword(s):  
Cerebral Artery ◽  
Cerebral Angiography ◽  
Anterior Cerebral Artery ◽  
The Other ◽  
Saccular Aneurysm ◽  
Resonance Imaging ◽  
Surgical Clipping ◽  
Magnetic Resonance Imaging Mri ◽  
Aneurysmal Neck ◽  
Difficult Cases

Some cases of aneurysms originating from the fenestrated A1 segment of the anterior cerebral artery (ACA) have been reported, but the pitfalls of the surgical procedure have not been well determined. We herein report 2 cases of a saccular aneurysm arising from the fenestrated A1 segment. Case 1 was a 72-year-old man incidentally diagnosed with an unruptured left ACA aneurysm on magnetic resonance imaging (MRI). Cerebral angiography revealed a saccular aneurysm arising from the proximal end of the left A1 segment. He underwent surgical clipping via the left pterional approach. The aneurysm originated from the proximal bifurcation of the fenestrated left A1 segment. A fenestrated ring clip was applied to obliterate the aneurysmal neck and one small fenestrated trunk, preserving the other fenestrated trunk and perforators around the fenestration. Case 2 was a 73-year-old man incidentally diagnosed with an unruptured ACA aneurysm on MRI. Cerebral angiography revealed a saccular aneurysm arising from the proximal end of the fenestrated left A1 segment. He underwent surgical clipping via the interhemispheric approach. The aneurysm originated from the proximal bifurcation of the fenestrated left A1 segment. A fenestrated ring clip was applied to obliterate the aneurysmal neck and one hypoplastic fenestrated trunk, preserving the other fenestrated trunk and perforators around the aneurysm. Detailed intraoperative evaluations of the anatomical structure and hemodynamics around the fenestration are important. The intentional obliteration of a fenestrated trunk and application of fenestrated clips need to be considered in difficult cases in order to expose the aneurysmal neck.

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