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[A Case of Embolic Infarction Associated with Accessory Middle Cerebral Artery and Treated Using Mechanical
Yuki Matsunaga1, Kentaro Hayashi, Kazuaki Okamura
1Department of Neurosurgery, Local Incorporated Administrative Agency, Sasebo City General Hospital.
Abstract:
The accessory middle cerebral artery(AMCA)is an anatomical variant of the MCA. It originates from the anterior cerebral artery, reaches the sylvian fissure, and supplies the territory of the middle cerebral artery. We report a case of embolic infarction associated with the AMCA that was treated using mechanical thrombectomy. An 82-year-old man with chronic atrial fibrillation experienced a sudden onset of left hemiparesis and was brought to our hospital. Magnetic resonance imaging showed a right temporal lobe, parietal lobe, and basal ganglion infarction, and indicated right internal carotid artery(ICA)occlusion. Mechanical thrombectomy using a Penumbra system was performed with complete recanalization. Final angiography revealed the existence of the AMCA, and the thrombus was located at the right ICA C2 portion to the main MCA. There have been twelve reported cases of ischemic stroke associated with the AMCA, including the present case. We summarized the data from the reported cases of ischemic stroke with an AMCA and evaluated their clinical characteristics and the pitfalls of endovascular treatment. These cases suggest that the AMCA may play a role in collateral flow around the main MCA occlusion, but provides insufficient collateral blood supply. Owing to the anatomical characteristics of the AMCA, we should pay attention to possible complications of endovascular treatment.
Insights
An accessory middle cerebral artery (AMCA) variant can lead to insufficient collateral blood flow during stroke, complicating mechanical thrombectomy. Careful consideration of AMCA anatomy is crucial for successful endovascular treatment.
Area of Science:
- Neurology
- Vascular Neurology
- Neuroimaging
Background:
- The accessory middle cerebral artery (AMCA) is an anatomical variant originating from the anterior cerebral artery.
- It supplies the territory typically covered by the middle cerebral artery (MCA).
Observation:
- A case of embolic infarction in an 82-year-old male with atrial fibrillation presented with left hemiparesis.
- Imaging revealed right temporal, parietal, and basal ganglia infarction with right internal carotid artery (ICA) occlusion.
- Mechanical thrombectomy achieved complete recanalization, with angiography confirming the presence of an AMCA.
Findings:
- This case, along with eleven previously reported, highlights ischemic stroke associated with AMCA.
- AMCA may offer limited collateral flow during MCA occlusion.
- Endovascular treatment of AMCA-associated strokes presents unique challenges.
Implications:
- The AMCA's anatomical features necessitate attention to potential complications during endovascular procedures.
- Understanding AMCA's role in collateral circulation is vital for stroke management.
- Further research into optimizing endovascular techniques for AMCA variants is warranted.
