The Angiographic Anatomy of the Sphenoidal Segment of the Middle Cerebral Artery and Its Relevance in Mechanical Thrombectomy

Abstract

Objective: The middle cerebral artery (MCA) is the most commonly treated artery in mechanical thrombectomy stroke trials; however, there is no pragmatic agreement about the segmental anatomy and nomenclature utilized. It results in significant clinical-radiological dissociation and introduces bias in research trials. The purpose of the study is to review and compare angiographic anatomy with microsurgical anatomy literature of the MCA with emphasis on the discrepancy. Methodology: Consecutive cerebral angiograms between January 2011 and March 2014 were retrospectively reviewed by endovascular surgical neuroradiologists. Information about the anatomy of the sphenoidal segment of the MCA classified as classic and non-classic pattern, the lenticulostriate artery takeoff pattern, and the course angulation of the sphenoidal segment were studied. Results: A total of 500 patients, 886 cerebral angiograms, were reviewed. We found the classic pattern of the main trunk MCA bifurcation and a straight angulation course in less than half of the cases. The lenticulostriate arteries arose not only from the main trunk but also from its divisions in more than half of the cases. Conclusion: It is important to corroborate our findings and to develop a pragmatic classification to accurately assess MCA occlusions from the radiological and clinical perspective.

Angiographic Systems for Classifying Distal Arterial Occlusions

“…It may supply some parts of the eloquent posterior temporal cortex, especially if the middle temporal and/or posterior temporal arteries are small [26]. Khatri et al [27] in their review of 886 cerebral angiograms concluded that the anterior temporal artery, regardless of its size, was not considered to determine the main MCA bifurcation pattern, whereas Goyal et al stated that anterior temporal artery is not considered M2; however, if the artery is large, i.e., supplies territories outside those of the anterior temporal artery such as posterior temporal or low parietal region, it should be considered as M2 [14]. Another study defined the hTA/holo-temporal M2 branch as an isolated branch of the M1 segment giving origin to the anterior temporal artery and arteries supplying the middle and posterior temporal lobes and possibly reaching the inferior parietal and temporo-occipital territories.…”

“…It may supply some parts of the eloquent posterior temporal cortex, especially if the middle temporal and/or posterior temporal arteries are small [26]. Khatri et al [27] in their review of 886 cerebral angiograms concluded that the anterior temporal artery, re- [18] From the origin of the main trunk at the ICA to its main divisions (bifurcation)…”

“…Khatri 2020 [27] From the origin of the main trunk to the point of bifurcation of the sphenoidal segment -this point was noted by drawing a perpendicular line from the angiographic Sylvian point…”