In-vivo Assessment of the Proximal Branches of the Anterior Cerebral Artery Using Rotational Angiography

The anatomy of the proximal anterior cerebral artery (ACA) and its branches, including the recurrent artery of Heubner (RAH) and medial lenticulostriate arteries (MLSAs), is known for frequent variations. Impairment of these branches can result in severe consequences, including neurological deficits or cognitive impairment. This study aimed to analyze these branches and their variations in vivo, using data from 3D rotational angiographies (3D-RA).

We reviewed 3D-RAs of 209 hemispheres from 191 patients with pathologies remote from the region of interest. The presence, origin and course of the RAH were investigated. Delineation, origin and number of perforator vessels originating from the A1 segment (MLSAs) were assessed.

The RAH was observed in 151 hemispheres (72%), including a single RAH in 144 (69%) and a doubled RAH in 7 (3%) hemispheres. In 37% of cases, the RAH originated from the A1 segment, in 56% from the A1/A2 transition, and in 7% from the A2 segment. In the presence of RAH, additional MLSAs originating from the A1 segment were present in 25% of hemispheres. A weak negative correlation was identified between the presence of one or two RAH and the frequency of additional MLSAs.

The study revealed significant differences in the presence and anatomical course of RAH and MLSAs compared to previous research. The findings highlight the importance of 3D-RA in visualizing the complex anatomy of the ACA, particularly to avoid complications during surgical or endovascular procedures.