Anomalous origin of a middle cerebral artery from anterior cerebral artery with no association to an accessory or duplicated middle cerebral artery
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Abstract:
The middle cerebral artery (MCA) is one of the major paired intracranial arteries involved in the formation of the circle of Willis. MCA is the most complex of the intracranial arteries mainly because it supplies the cerebral neocortex, which has been significantly developed in humans. The MCA is a recent phylogenetic acquisition and can be considered as a collateral branch of the anterior cerebral artery (ACA). Anomalies of the middle cerebral artery are less commonly reported than other intracranial arteries. Previously, described anomalies include accessory MCA, duplicated MCA, fenestration of MCA and variations of the branching patterns. Recently, several reports have been published describing unfused or twig-like MCA, in which the single MCA trunk is substituted by a collateral plexiform arterial network. This manuscript would like to report our unique case of an anomalous MCA origin from the anterior cerebral artery unassociated with duplication or accessory MCA.Keywords:
Anterior cerebral artery
Anterior communicating artery
Circle of Willis
Posterior cerebral artery
Circle of Willis
Anterior cerebral artery
Posterior communicating artery
Posterior cerebral artery
Anterior communicating artery
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Arterial bifurcations in the circle of Willis were observed three-dimensionally in 44 cases of cerebral aneurysm and 45 control cases. Variations of the circle of Willis were also studied in relation to cerebral aneurysm. The following results were obtained : 1. Aneurysm always occurred at the apex of the cerebral arterial bifurcation where axial flow in the parent artery immediately proximal to the aneurysm was assumed to impinge. 2. A statistically valid correlation was found between cerebral aneurysm and anterior middle cerebral artery. A statistically valid correlation was also noted between the external diameter of the parent arteries and the side of aneurysms in 19 anterior communicating aneurysms and 5 posterior communicating aneurysms. When the proximal portion of the anterior cerebral artery or when the posterior communicating artery was thicker than the contralateral one, the aneurysm tended to occur on the thicker side. 3. One aneurysm developed on a dilated feeding artery of an associated cerebral arterio-venous malformation. Another one developed at the proximal branching point from an associated accessory middle cerebral artery. These results show the preponderence of the occurrence of cerebral aneurysm at sites where blood flow is relatively abundant because of some variation in the form of the circle of Willis. They also suggest that hemodynamic stress plays an important role in the pathogenesis of cerebral aneurysm.
Circle of Willis
Anterior cerebral artery
Anterior communicating artery
Posterior cerebral artery
Posterior communicating artery
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Assessment of intracranial hemodynamics in carotid artery disease by transcranial Doppler ultrasound
✓ Noninvasive transcranial Doppler recordings were correlated to the angiographic findings in 77 patients with carotid artery disease. Stenoses reducing the luminal area of the internal carotid artery by 75% or more also reduced the pulsatility transmission index (PTI) of the ipsilateral middle cerebral artery (MCA). The PTI is the pulsatility index of the artery under study expressed as a percent of the pulsatility index of another intracranial artery with presumed unimpeded inflow in the same individual. For stenoses in the 75% to 89% category, PTI reduction was significantly greater in patients with bilateral carotid stenosis, indicating an impaired potential for collateral flow in these patients. The PTI reduction probably reflects both the pressure drop across the stenosis and the cerebral autoregulatory response. Two criteria proved useful in demonstrating collateral MCA supply through the circle of Willis. On the recipient side, retrograde flow in the proximal anterior cerebral artery was demonstrated in 29 of the 31 patients when this flow pattern was disclosed angiographically. In 26 of these patients, the anterior cerebral artery on the supplying side also had clearly increased flow velocity. Increased flow velocities in the proximal posterior cerebral artery were present in 26 of the 30 vessels that were acting as a collateral channel to the ipsilateral MCA.
Transcranial Doppler
Carotid artery disease
Doppler ultrasound
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Circle of Willis
Anterior cerebral artery
Transcranial Doppler
Posterior cerebral artery
Anterior communicating artery
Posterior communicating artery
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Introduction: The circle of Willis (CoW), which is located at the base of the brain is the most important anastomosis between the internal carotid and vertebral system. It is the main distributor of blood to the brain. Methods: CT head and CT angiography were performed using standard scan parameters. Only the tests with normal radiological reports and appropriate technical standards were included in the study. Component of circle of Willis: Anterior cerebral artery (ACA), Middle cerebral artery (MCA), Anterior communicating artery (Acom), Posterior Communicating artery (PCom), Basilar artery (BA) and Posterior cerebral artery (PCA) were identified and their internal diameter were measured. Results: Basilar artery was the artery with largest internal diameter with mean diameter of 2.5 ±0.52 mm. Men had significantly larger arterial sizes than women in all of the intracranial arteries examined except right PCom, Left PCom and right MCA. Right ACA had significantly larger internal diameter in <40 years’ age group. BA, left PCA, Bilateral PCom and MCA showed larger diameter in age group ≥40 years. Conclusion: Men had significantly larger arterial sizes than women in all of the intracranial arteries examined except right PCom, Left PCom and right MCA.
Circle of Willis
Posterior communicating artery
Anterior communicating artery
Anterior cerebral artery
Posterior cerebral artery
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Abstract The circle of Willis was dissected in 75 Macaca mulatta monkeys, and the anatomy is described and compared with several series of human specimens. The principal difference between monkey and man is the presence of a single distal anterior cerebral artery in the former, and the most common anomaly in the moneky is an anterior communicating artery proximal to the junction of the anterior cerebral arteries. A large vessel joining the internal carotid arteries and an accessory branch of the anterior cerebral artery, probably communicating with the external carotid circulation, were found in a small number of our specimens. In man the posterior communicating is significantly reduced in diameter far more frequently than the anterior communicating artery, whereas the reverse situation obtains in the monkey. In general, the intracranial distribution of blood in the moneky is the same as in man, because the similarities in the normal anatomy and variations i the circle of Willis outweight their differences. However, physiological data on collateral cerebral circulation will be more meaningful when it is based on the arterial anatomy in each preparation.
Circle of Willis
Anterior cerebral artery
Anterior communicating artery
Posterior cerebral artery
Collateral circulation
Posterior communicating artery
Cerebral circulation
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✓ The anterior perforating arteries, the group of arteries that enter the brain through the anterior perforated substance (APS), were examined using × 3 to × 40 magnification in 50 cerebral hemispheres obtained from 25 adult cadavers. These arteries arose from the internal carotid, middle and anterior cerebral, and the anterior choroidal arteries. The carotid branches to the APS arose distal to the origin of the anterior choroidal artery. The anterior choroidal artery branches arose from the main or superior branch of the artery. The middle cerebral artery branches to the APS (the lenticulostriate arteries) arose from the M 1 and M 2 segments and were divided into medial, intermediate, and lateral groups, each of which had a characteristic configuration. The anterior cerebral artery branches arose from the A 1 segment and from the recurrent artery. The internal carotid and anterior choroidal artery branches entered the posterior half of the central portion of the APS. The lenticulostriate branches entered the middle and posterior portions of the lateral half of the APS. The A 1 segment gave rise to branches which entered the medial half of the APS above the optic nerve and chiasm. The recurrent artery sent branches into the anterior two-thirds of the full mediolateral extent of the APS. The relationship of these branches to the cerebral structures above the APS and to the common aneurysm sites is reviewed.
Anterior choroidal artery
Anterior cerebral artery
Perforating arteries
Anterior communicating artery
Posterior cerebral artery
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Citations (249)
The middle cerebral artery (MCA) is one of the major paired intracranial arteries involved in the formation of the circle of Willis. MCA is the most complex of the intracranial arteries mainly because it supplies the cerebral neocortex, which has been significantly developed in humans. The MCA is a recent phylogenetic acquisition and can be considered as a collateral branch of the anterior cerebral artery (ACA). Anomalies of the middle cerebral artery are less commonly reported than other intracranial arteries. Previously, described anomalies include accessory MCA, duplicated MCA, fenestration of MCA and variations of the branching patterns. Recently, several reports have been published describing unfused or twig-like MCA, in which the single MCA trunk is substituted by a collateral plexiform arterial network. This manuscript would like to report our unique case of an anomalous MCA origin from the anterior cerebral artery unassociated with duplication or accessory MCA.
Anterior cerebral artery
Anterior communicating artery
Circle of Willis
Posterior cerebral artery
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Introduction : This study aimed to determine what anatomical variants of the Circle of Willis (CoW) and the middle cerebral artery(MCA) are observed in patients with acute M1 occlusion and whether their prevalence differs from that described as “normal” in anatomy textbooks. Methods : We have performed a retrospective assessment of radiological examinations of patients with stroke due to middle cerebral artery M1 segment occlusion. All patients underwent mechanical thrombectomy from January 2015 until March 2021. The anatomy of the CoW was assessed on initial CT‐angiography and DSA. Branches of the MCA were observed on control DSA after recanalization. Results : A total of 100 patients were included in the analysis (58 females and 42 males, mean age: 71.6 +/‐ 13.9). Fully complete CoW was observed in 19% of patients. A total of 10% of patients had an incomplete anterior portion of CoW. In the incomplete anterior portion subgroup, the most common variation was the absence of anterior communicating artery (6% of total hemispheres), followed by the absence of one A1 (3% of total hemispheres). An incomplete posterior portion of CoW was identified in 79% of the patients. The absence of posterior communicating artery (PCoA) was observed in 59 patients. Sixteen patients had adult‐type PCoA, 3 patients had transitional‐type PCoA and 21 patients had fetal‐type posterior cerebral artery (PCA). In the subgroup of patients with fetal‐type posterior circle, 5 patients had no P1 segment of PCA. Anterior temporal branch of MCA was observed in 45% of the patients. Middle cerebral artery bifurcation was found in 80% of hemispheres, and trifurcation in 20%. In the bifurcation subgroup, 26% of MCAs had a dominating upper branch and 18% had a dominating lower branch. A duplicate MCA was observed in one hemisphere. Conclusions : In comparison to normal anatomy described in anatomy textbooks, the population of patients suffering from ischemic stroke due to M1 occlusion had a lower proportion of complete and closed CoW. A foetal type PCoA was observed to be prevalent (21%) in patients suffering from acute M1 occlusion. Detailed anatomical knowledge of anatomical variants of CoW in patients undergoing mechanical thrombectomy is essential for clinicians performing intravascular interventions and may aid procedure planning.
Anterior cerebral artery
Posterior cerebral artery
Circle of Willis
Posterior communicating artery
Anterior communicating artery
Stroke
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Anterior communicating artery
Circle of Willis
Anterior cerebral artery
Posterior cerebral artery
Posterior communicating artery
Digital subtraction angiography
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