Aneurysmal subarachnoid hemorrhage in a patient with bilateral A1 fenestrations associated with an azygos anterior cerebral artery

1996 ◽  
Vol 84 (4) ◽  
pp. 681-684 ◽  
Author(s):  
Robert M. Friedlander ◽  
Christopher S. Ogilvy
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Vascular Anatomy ◽  
Vascular Anomaly ◽  
Rare Occurrence ◽  
Content Type ◽  
Proximal Anterior Cerebral Artery ◽  
Current Article

✓ Fenestration of the proximal anterior cerebral artery (A1 segment) is a rare occurrence. This vascular anomaly is often associated with aneurysms and other abnormalities. The current article describes the case of a 33-year-old man who presented with a subarachnoid hemorrhage secondary to a ruptured aneurysm originating from the proximal end of an A1 fenestration. This patient also had a contralateral A1 fenestration as well as an azygos anterior cerebral artery. This is the first report of such an unusual vascular anatomy. The literature is reviewed and possible embryological mechanisms are discussed.

THE IMPACT OF BALLOON ANGIOPLASTY ON THE EVOLUTION OF VASOSPASM-RELATED INFARCTION AFTER ANEURYSMAL SUBARACHNOID HEMORRHAGE

Neurosurgery ◽  
2008 ◽  
Vol 62 (3) ◽  
pp. 610-617 ◽  
Author(s):  
Leonie Jestaedt ◽  
Mirko Pham ◽  
Andreas J. Bartsch ◽  
Ekkehard Kunze ◽  
Klaus Roosen ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Balloon Angioplasty ◽  
Anterior Cerebral Artery ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Fisher Exact Test ◽  
Computed Tomographic ◽  
Fisher Grade ◽  
The Impact

Abstract OBJECTIVE Vasospasm of the cerebral vessels remains a major source for morbidity and mortality after aneurysmal subarachnoid hemorrhage. The purpose of this study was to evaluate the frequency of infarction after transluminal balloon angioplasty (TBA) in patients with severe subarachnoid hemorrhage-related vasospasm. METHODS We studied 38 patients (median Hunt and Hess Grade II and median Fisher Grade 4) with angiographically confirmed severe vasospasm (>70% vessel narrowing). A total of 118 vessels with severe vasospasm in the anterior circulation were analyzed. Only the middle cerebral artery, including the terminal internal carotid artery, was treated with TBA (n = 57 vessel segments), whereas the anterior cerebral artery was not treated (n = 61 vessel segments). For both the treated and the untreated vessel territories, infarction on unenhanced computed tomographic scan was assessed as a marker for adverse outcome. RESULTS Infarction after TBA occurred in four middle cerebral artery territories (four out of 57 [7%]), whereas the infarction rate was 23 out of 61 (38%) in the anterior cerebral artery territories not subjected to TBA (P < 0.001, Fisher exact test). Three procedure-related complications occurred during TBA (dissection, n = 1; temporary vessel occlusions, n = 2). One of these remained asymptomatic, whereas this may have contributed to the development of infarction on follow-up computed tomographic scans in two cases. CONCLUSION In a population of patients with a high risk of infarction resulting from vasospasm after subarachnoid hemorrhage, the frequency of infarction in the distribution of vessels undergoing TBA amounts to 7% and is significantly lower than in vessels not undergoing TBA despite some risk inherent to the procedure.

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.

Paradoxical aggravation of vasospasm with papaverine infusion following aneurysmal subarachnoid hemorrhage

1996 ◽  
Vol 84 (4) ◽  
pp. 690-695 ◽  
Author(s):  
Brent L. Clyde ◽  
Andrew D. Firlik ◽  
Anthony M. Kaufmann ◽  
MichaelP. Spearman ◽  
Howard Yonas
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Artery ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Left Middle Cerebral Artery ◽  
Xenon Ct ◽  
Content Type ◽  
Symptomatic Vasospasm ◽  
Fine Print

✓ Reports of intraarterial papaverine infusion as treatment for cerebral vasospasm are few and documented complications are uncommon. The authors report the case of a patient with paradoxical aggravation of cerebral arterial narrowing during selective intraarterial papaverine infusion intended to treat vasospasm following aneurysmal subarachnoid hemorrhage (SAH). A 48-year-old man presented to the authors' service with symptomatic vasospasm 10 days after experiencing an SAH. The ruptured anterior communicating artery aneurysm was surgically obliterated the following day, and thereafter maximum hypervolemic and hypertensive therapies were used. However, the patient remained lethargic, and a stable xenon—computerized tomography (CT) cerebral blood flow (CBF) study revealed CBF to be 15 cc/100 g/minute in the left anterior cerebral artery (ACA) and 25 cc/100 g/minute in the right ACA territories. Cerebral arteriography demonstrated diffuse severe left ACA and mild left middle cerebral artery (MCA) vasospasm. In response intraarterial papaverine was infused into the internal carotid artery just proximal to the ophthalmic artery. During the infusion the patient became aphasic and exhibited right hemiplegia. Arteriography performed immediately after the intraarterial papaverine infusion revealed diffuse exacerbation of vasospasm in the distal ACA and MCA territories. A repeat xenon—CT CBF study showed that CBF in the left ACA and the MCA had drastically decreased (2 cc/100 g/minute and 10 cc/100 g/minute, respectively). Despite aggressive management, infarction ultimately developed. This is the first clinical case to illustrate a paradoxical effect of intraarterial papaverine treatment for vasospasm following aneurysmal SAH. The possible mechanisms of this paradoxical response and potential therapeutic reactions are reviewed.

scholarly journals Safety and efficacy of balloon angioplasty of the anterior cerebral artery for vasospasm treatment after subarachnoid hemorrhage

2017 ◽  
Vol 23 (4) ◽  
pp. 372-377 ◽  
Author(s):  
Nauman S Chaudhry ◽  
Jennifer L Orning ◽  
Sophia F Shakur ◽  
Sepideh Amin-Hanjani ◽  
Victor A Aletich ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Artery ◽  
Balloon Angioplasty ◽  
Anterior Cerebral Artery ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Infusion Therapy ◽  
Safety And Efficacy ◽  
Neurological Improvement ◽  
Symptomatic Vasospasm ◽  
Radiographic Measurements

Balloon angioplasty is often performed for symptomatic vasospasm following aneurysmal subarachnoid hemorrhage. Angioplasty of the anterior cerebral artery (ACA), however, is perceived to be a challenging endeavor and not routinely performed due to technical and safety concerns. Here, we evaluate the safety and efficacy of balloon angioplasty of the anterior cerebral artery for vasospasm treatment. Patients with vasospasm following subarachnoid hemorrhage who underwent balloon angioplasty at our institution between 2011 and 2016 were retrospectively reviewed. All ACA angioplasty segments were analyzed for pre- and post-angioplasty radiographic measurements. The degree of vasospasm was categorized as mild (<25%), moderate (25–50%), or severe (>50%), and relative change in caliber was measured following treatment. Clinical outcomes following treatment were also assessed. Among 17 patients, 82 total vessel segments and 35 ACA segments were treated with balloon angioplasty. Following angioplasty, 94% of segments had increased caliber. Neurological improvement was noted in 75% of awake patients. There were no intra-procedural complications, but two patients developed ACA territory infarction, despite angioplasty treatment. We demonstrate that balloon angioplasty of the ACA for vasospasm treatment is safe and effective. Thus, ACA angioplasty should be considered to treat vasospasm in symptomatic patients recalcitrant to vasodilation infusion therapy.

The results of proximal anterior cerebral artery occlusion for anterior communicating aneurysms

1972 ◽  
Vol 37 (1) ◽  
pp. 65-70 ◽  
Author(s):  
Herman Hugenholtz ◽  
Thomas P. Morley
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Late Results ◽  
Artery Occlusion ◽  
Recurrent Hemorrhage ◽  
Content Type ◽  
Proximal Anterior Cerebral Artery ◽  
Cerebral Artery Occlusion ◽  
Fine Print

✓ A 3- to 10-year follow-up of a selected group of 23 patients treated for ruptured anterior communicating aneurysms by proximal clipping of one anterior cerebral artery has been evaluated. There was no instance of recurrent hemorrhage. The operation carried a relatively low morbidity and mortality (13%). Early and late results are compared. The importance of adequate preoperative angiography, the minimal complications, and the advantages of the procedure are discussed.

A combined technique for treating certain aneurysms of the anterior communicating artery

1970 ◽  
Vol 33 (1) ◽  
pp. 41-47 ◽  
Author(s):  
George T. Tindall ◽  
John Kapp ◽  
Guy L. Odom ◽  
Stephen C. Robinson
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Operative Procedure ◽  
Anterior Communicating Artery ◽  
Recurrent Hemorrhage ◽  
Content Type ◽  
Proximal Anterior Cerebral Artery ◽  
Carotid Vessels ◽  
Intravascular Pressure

✓ Thirty-one patients with aneurysms of the anterior communicating artery that filled from both sides during carotid arteriography were treated by a combined operative procedure consisting of clip-ligation of one proximal anterior cerebral artery followed by gradual occlusion of the opposite common carotid artery with a Crutchfield clamp. In 14 patients, intravascular pressure recordings in the carotid vessels in the neck were obtained both before and immediately after ligation of the anterior cerebral artery. Before ligation the average intravascular pressure reduction was 55%, while after ligation the average reduction was 71%. Of the 31 patients, 22 have had good results and no recurrent hemorrhage. Nine patients died, four from recurrent hemorrhage. Follow-up carotid arteriography in nine patients showed the aneurysm obliterated in six, smaller in one, and unchanged in two. The results of this study indicate that treatment of certain anterior communicating aneurysms by the combined operative approach described is useful.

Aneurysm of a persistent primitive olfactory artery

1995 ◽  
Vol 83 (1) ◽  
pp. 138-140 ◽  
Author(s):  
Takehisa Tsuji ◽  
Masamitsu Abe ◽  
Kazuo Tabuchi
Keyword(s):  
Carotid Artery ◽  
Olfactory Bulb ◽  
Internal Carotid Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Anterior Cerebral Artery ◽  
Vascular Anomaly ◽  
Content Type ◽  
Aberrant Artery ◽  
Fine Print

✓ A ruptured anterior cerebral artery (ACA) aneurysm is reported in a patient in whom an anomalous ACA arose from the internal carotid artery at the bifurcation. The aberrant artery coursed anteriorly along the ipsilateral olfactory tract and made a hairpin turn posterior to the olfactory bulb, supplying the circulation of the ACA. Persistence of the primitive olfactory artery is suggested as an embryological origin of this vascular anomaly.

Proximal occlusion of the anterior cerebral artery for anterior communicating aneurysm

1975 ◽  
Vol 43 (4) ◽  
pp. 426-431 ◽  
Author(s):  
Anthony D. Hockley
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Artery Occlusion ◽  
Anterior Communicating Artery ◽  
Content Type ◽  
Mortality And Morbidity ◽  
Proximal Anterior Cerebral Artery ◽  
Technical Simplicity ◽  
Proximal Occlusion ◽  
Cerebral Artery Occlusion

✓ Results of proximal anterior cerebral artery occlusion are described in 68 patients with anterior communicating artery aneurysms. The procedure is found useful in the treatment of these aneurysms because of its technical simplicity and the low rates of mortality and morbidity achieved.

Subarachnoid hemorrhage from a ruptured anterior cerebral artery aneurysm caused by polyarteritis nodosa

2002 ◽  
Vol 96 (1) ◽  
pp. 132-134 ◽  
Author(s):  
Jun C. Takahashi ◽  
Nobuyuki Sakai ◽  
Koji Iihara ◽  
Hideki Sakai ◽  
Toshio Higashi ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Artery ◽  
Polyarteritis Nodosa ◽  
Anterior Cerebral Artery ◽  
Artery Aneurysm ◽  
Aneurysm Rupture ◽  
Inflammatory Infiltration ◽  
Content Type ◽  
Aneurysm Wall ◽  
Visceral Arteries

✓ Polyarteritis nodosa (PAN) is a rare systemic necrotizing arteritis that involves small- and medium-sized arteries in various organs. Although aneurysm formation in visceral arteries is a typical finding in PAN, intracranial aneurysms are much less common, and only a few cases of aneurysm rupture associated with this disease have been documented. In this paper, the authors report on a ruptured PAN aneurysm of the anterior cerebral artery; the lesion was trapped and resected. On histological examination, extensive fibrinoid necrosis and an inflammatory infiltration of leukocytes were seen in the aneurysm wall. To the authors' knowledge this is the first report of subarachnoid hemorrhage from a histologically confirmed PAN aneurysm.

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