Infraoptic course of anterior cerebral artery coexistence with double fenestration of proximal A2 segment of anterior cerebral artery with associated dysplastic anterior communicating artery aneurysm treated with stent-assisted coiling

Mahajan, Anshu; Banga, Vinit; Chatterjee, Apratim; Goel, Gaurav

doi:10.4103/ajns.ajns_193_19

Cited by 8 publications

(5 citation statements)

References 8 publications

(7 reference statements)

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“…11 Rarely, the A2 segment of the ACA can be associated with fenestration, and fenestration is often located at the beginning of the A2 segment. [12][13][14] Exceptionally, the AACA trunk can have a fenestration at the A2 segment beginning, as in our case. Intracranial arterial fenestration has an angiographical incidence of 0.3%-0.9% and is often observed in posterior circulation, unusually in anterior circulation.…”

Section: Discussionmentioning

confidence: 93%

Stenting-assisted embolization of a saccular aneurysm of the azygos anterior cerebral artery associated with fenestration at its beginning

2022

Neuroradiol J

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Aneurysms of the azygos anterior cerebral artery (AACA) associated with fenestration are exceptional. We reported such a case. A 61-year-old woman presented with subarachnoid hemorrhage. Computed tomography angiography and digital subtraction angiography showed an aneurysm at the distal end of the AACA with a fenestration at its beginning. Stenting-assisted coiling of the aneurysm was performed. The postoperative recovery was uneventful. Follow-up DSA showed complete coiling of the aneurysm. By this case report and review of the literature, we found that the coexistence of the aneurysm and fenestration on the AACA was exceptional. Endovascular treatment of saccular AACA aneurysms is an appealing option.

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Section: Discussionmentioning

confidence: 93%

Stenting-assisted embolization of a saccular aneurysm of the azygos anterior cerebral artery associated with fenestration at its beginning

2022

Neuroradiol J

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“…Different authors reported cases of aneurysms associated with infraoptic ACAs [ 20 ]. These were found on the AComA or on the A1 or A2 segments of the ACA [ 4 , 5 , 7 , 8 , 13 , 18 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. An aneurysm on an infraoptic A1 segment of an azygos ACA was also reported [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

The Infraoptic or Infrachiasmatic Course of the Anterior Cerebral Artery Emerging an Elongated Internal Carotid Artery

et al. 2022

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(1) Background: The normal A1 segment of the anterior cerebral artery (ACA) has a supraoptic course. The proximal infraoptic course of an A1 segment leaving the internal carotid artery (ICA) near the origin of the ophthalmic artery is a rare possibility. This study aimed to determine the prevalence and detailed anatomy of infraoptic A1 segments. (2) Methods: We retrospectively studied 145 computed tomography angiograms from 92 male and 53 female cases, with ages varying from 61 to 78 y.o. (3) Results: In 21/145 cases, infraoptic or infrachiasmatic horizontal-medial courses of A1 segments that emerged distally from the ICA were found. Distal infraoptic A1 segments were bilateral in 16/145 cases and unilateral in 3/145 cases. Infrachiasmatic A1 segments were found bilaterally in 2/145 male cases. All the infraoptic/infrachiasmatic A1 segments left long ICAs with low bifurcations. In 7/34 sides with distal infraoptic or infrachiasmatic A1 segments, supracarotid courses were present. In one female, the right A1 segment had an anterior supraclinoid, supracarotid and infraoptic course. In two female cases with a bilateral distal infraoptic A1, the segment was almost contacting the respective posterior cerebral artery. (4) Conclusions: In cases with dolicho(ectatic) ICAs, the A1 segments could have infraoptic and supracarotid courses the neurosurgeons should be aware of.

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“…Fenestrations have been described in the A1 segment of the anterior cerebral artery, although the most frequently affected segment of the anterior circulation is the Anterior communicating artery (Acom) (Mamadaliev et al, 2019;Trandafilovic et al, 2021). As with all other vascular disorders, cerebral angiography is invaluable in their accurate diagnosis (Mahajan et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

“…The distal A1 segment is described as the most frequently associated with fenestrations in dissections of cadavers. Various theories have been reported to explain the association between aneurysms and fenestrations, including: Vascular wall weakness (Iwabuchi et al, 2018), and failure of fusion of the plexiform multi-channel network of vessels that develop into major arteries during fetal life (Krystkiewicz et al, 2021;Kwon et al, 2013;Mahajan et al, 2020;Makowicz et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

A1-A2 anterior cerebral artery fenestration. a case report of a rare anatomical variant

Hovrin¹,

Senko²,

Musa³

et al. 2022

EJA

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Cerebral vascular anatomical variations are not uncommon in the human population. Their prevalence is not exactly known, as most of them are incidentally diagnosed on angiography or postmortem dissections. We present a rare fenestration of the A1 segment of the anterior cerebral artery presenting with a ruptured saccular aneurysm. A 42-year-old hypertensive patient presented unconscious following a ruptured saccular aneurysm. The computer tomography angiography showed a fenestration of the right A1 segment of the anterior cerebral artery (ACA). The medial segment of the A1 was communicating with the left ACA via the Anterior communicating artery, while the lateral segment was directly joining the A2 segment of the same side. Intraoperatively, the two segments were identified as separate vascular structures not sharing adventitia, and of equal caliber. The aneurysm arising from the bifurcation was clipped. The patient recovered with no neurological deficits. Many vascular anomalies like fenestrations and bifurcations are underdiagnosed, as many of them remain asymptomatic and are discovered incidentally on postmortem dissection or angiography for other pathologies. This has led to a paucity of cases to determine the prevalence in the human population. Good knowledge of the vascular anatomy variations and associated risk of aneurysm is important for the vascular neurosurgeons.

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Infraoptic course of anterior cerebral artery coexistence with double fenestration of proximal A2 segment of anterior cerebral artery with associated dysplastic anterior communicating artery aneurysm treated with stent-assisted coiling

Abstract: Infraoptic course of anterior cerebral artery coexistence with double fenestration of proximal A2 segment of anterior cerebral artery with associated dysplastic anterior communicating artery aneurysm treated with stent-assisted coiling.

Cited by 8 publications

References 8 publications

Stenting-assisted embolization of a saccular aneurysm of the azygos anterior cerebral artery associated with fenestration at its beginning

Stenting-assisted embolization of a saccular aneurysm of the azygos anterior cerebral artery associated with fenestration at its beginning

The Infraoptic or Infrachiasmatic Course of the Anterior Cerebral Artery Emerging an Elongated Internal Carotid Artery

A1-A2 anterior cerebral artery fenestration. a case report of a rare anatomical variant

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