Carotid-Anterior Cerebral Artery Anastomosis with Aneurysm: Case Report and Review of the Literature

Abstract

A ruptured aneurysm at the origin of the bilateral pericallosal arteries with an anomalous anterior cerebral artery was found in a 56-year-old man. The abnormal solitary anterior cerebral artery arose from the intracranial proximal internal carotid artery, passed underneath the ipsilateral optic nerve, and turned upward at the midline as a common trunk of the bilateral pericallosal arteries. Subarachnoid hemorrhage recurred 15 days postoperatively, and the patient did poorly. The 20 published cases of this rare anomaly (an infraoptic course of the anterior cerebral artery with a low bifurcation of the internal carotid artery) are reviewed. This anomaly should be referred to by the descriptive term "carotid-anterior cerebral artery anastomosis." It is frequently associated with aneurysms.

Bilateral Infraoptic Origin of Anterior Cerebral Arteries: A Rare Anomaly and its Embryological and Clinical Significance

“…The artery then ascends medially to join normally positioned anterior communicating artery. Although a supraoptic A1 connection is not shown in our case, an associated normally positioned but extremely hypoplastic A1 has been reported 4,5 . Infraoptic A1 is unilateral in most cases with only three cases of a bilateral infraoptic course reported in the anatomic and neurosurgical literature 1 .…”

A Ruptured Aneurysm at the Infraoptic Azygous Anterior Cerebral Artery with the Contralateral Internal Carotid Artery Agenesis Treated by Y-stent Assisted Coil Embolization

“…The prevalence of intracranial aneurysms in association with infraoptic azygous ACA is high, probably due to local intrinsic structural and hemodynamic factors, and the most common site is the ACA-ACoA complex 3)6)7)8)11)12)15)16)17). However, according to previous reports, aneurysm formation may occur anywhere 1)4)…”

“…An infraoptic ACA originating from the extradural ICA was reported in only four of these previous cases 1)4)6)8). Various terminologies, including infraoptic ACA and carotid-ACA anastomosis, have been used 12)14). This ACA anomaly is characterized by three features: an anomalous artery branches off from the ICA at the level of the OA, it courses beneath the optic nerve, and supplies the territory of the normal ACA 9)12)17).…”

“…Various terminologies, including infraoptic ACA and carotid-ACA anastomosis, have been used 12)14). This ACA anomaly is characterized by three features: an anomalous artery branches off from the ICA at the level of the OA, it courses beneath the optic nerve, and supplies the territory of the normal ACA 9)12)17). Our patient also presented with these features, and, in addition, showed an unusual anomaly of the contralateral ICA agenesis with the prominent PCoA solely providing collateral flow to the MCA territory; these findings appeared to show a close association with formation of the azygous ACA with the solitary midline trunk from where the bilateral branches of the distal ACA and the bilateral recurrent arteries of Heubner originated.…”

Bilateral infraoptic A1 arteries in association with a craniopharyngioma: Case report and review of the literature

“…In the most commonly reported anatomic variation, the infraoptic A1 takes its origin from the right ICA and continues as a large-caliber vessel that directly supplies the distal ACA territories bilaterally, with associated hypoplasia or agenesis of the contralateral A1. [56925303234] Closely correlated with this altered hemodynamic state is an overall increased frequency of cerebral aneurysms reported in association with the infraoptic A1, with the ACA-AComm complex representing the single most common site of aneurysm formation. [91418242528–303240]…”