Clinical and radiological features of patients with aplastic or twiglike middle cerebral arteries
Byung-Sun Seo1, Yoon-Soo Lee, Hyuk-Gee Lee
1Department of Neurosurgery, Daegu Fatima Hospital, Daegu, Republic of Korea.
Background:
An aplastic or twiglike middle cerebral artery (Ap/T-MCA) is an extremely rare congenital anomaly related to interference in the normal embryonic development of the MCA.
Objective:
To evaluate the clinical and radiological features of patients with an Ap/T-MCA.
Methods:
A total of 1749 conventional cerebral angiography procedures were performed in 1282 patients from January 2005 to July 2011 at Daegu Fatima Hospital. The images were evaluated for cerebral arterial anomalies. The radiological features of an Ap/T-MCA, coexisting anomalies, and clinical manifestations were recorded. These prospectively maintained databases were analyzed retrospectively.
Results:
Ap/T-MCAs were found in 15 patients (1.17% angiographic incidence). The anomalies were confined to unilateral M1 segment, and no stenoses were seen in the adjacent major arteries. Of 15 patients, 6 (40%) had hemorrhagic strokes, 5 (33.3%) had ischemic strokes, and 4 (26.7%) had no symptoms. Aneurysms were found in 5 patients (33.3%). Coexisting cerebral arterial anomalies were seen in 12 patients (80%). Ten patients underwent conservative treatments, and the remaining 5 underwent surgical treatments, such as hematoma aspiration, indirect revascularization, and clipping or coiling of aneurysms.
Conclusion:
An Ap/T-MCA is a rare anomaly and should be differentiated from moyamoya conditions and degenerative steno-occlusive diseases of the middle cerebral artery. Coexisting anomalies of the anterior or middle cerebral arteries are frequent. This anomaly is vulnerable to both hemorrhagic and ischemic strokes.
Insights
Aplastic or twiglike middle cerebral artery (Ap/T-MCA) is a rare congenital anomaly. This condition frequently co-occurs with other cerebral artery anomalies and poses a risk for both hemorrhagic and ischemic strokes.
Area of Science:
- Neurology
- Radiology
- Vascular Surgery
Background:
- Aplastic or twiglike middle cerebral artery (Ap/T-MCA) is an extremely rare congenital anomaly.
- It results from disruptions in embryonic middle cerebral artery development.
Purpose of the Study:
- To evaluate the clinical and radiological features of patients diagnosed with Ap/T-MCA.
- To understand the associated anomalies and patient outcomes.
Main Methods:
- Retrospective analysis of 1749 cerebral angiographies from 1282 patients (2005-2011).
- Identification and characterization of Ap/T-MCA, coexisting anomalies, and clinical presentations.
Main Results:
- Ap/T-MCAs identified in 15 patients (1.17% incidence), affecting the unilateral M1 segment.
- 40% experienced hemorrhagic strokes, 33.3% ischemic strokes; 80% had coexisting cerebral arterial anomalies.
- 5 patients had aneurysms; treatments ranged from conservative to surgical interventions.
Conclusions:
- Ap/T-MCA is a rare anomaly requiring differentiation from moyamoya disease and other steno-occlusive conditions.
- Frequent co-occurrence with anterior/middle cerebral artery anomalies is noted.
- The anomaly is associated with a significant risk of both hemorrhagic and ischemic strokes.
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