A case of acute cerebral infarction associated with an accessory middle cerebral artery in a patient who underwent thrombectomy

Background

The accessory middle cerebral artery (AMCA) is a middle cerebral artery (MCA) anomaly originating from the anterior cerebral artery. We report our experience of a case in which thrombectomy was undertaken for a patient with hemodynamics that were specific to the AMCA.

Case Presentation

An 84‐year‐old man with a history of atrial fibrillation developed paralysis of the left upper and lower extremities. Imaging examinations suggested tandem occlusion of the right internal carotid artery and the origin (M2 segment) of the right MCA. An extremely narrow MCA was visualized. Because there was concern regarding development of frontal lobe infarction, thrombectomy was carried out to restore anterograde blood flow, but an AMCA was found. Recanalization of the main MCA in the infarction zone resulted in hemorrhagic infarction, and the patient died of cerebral herniation.

Conclusion

When a vascular variation like AMCA is suspected, a careful evaluation of hemodynamics is necessary before undertaking endovascular intervention.

Dissecting Aneurysm at the Proximal Segment of the Anterior Cerebral Artery Associated with Infraoptic Course Anterior Cerebral Artery

A 48-year-old man presented a subarachnoid hemorrhage caused by a rupture of a dissecting aneurysm at the proximal segment (A1 segment) of the right anterior cerebral artery (ACA). He also had an anomalous artery named infraoptic course ACA and an agenesis of the contralateral ACA A1 segment. Balloon occlusion test at the bifurcation of the right internal carotid artery demonstrated that the distal segments of the bilateral ACAs were perfused through the infraoptic course ACA. Therefore, we surgically trapped the A1 segment including the aneurysm. The patient got discharged without any neurological deficit. Natural course of ACA dissecting aneurysms is unclear because of rarity of the disease and treatment strategy is still controversial. Most of the dissecting aneurysms in the A1 segment are surgically treated, because they often present with massive hemorrhage and poor prognosis. In the present case, the contralateral A1 segment was absent but trapping of the dissecting aneurysm could be achieved without vascular reconstruction (e.g., bypass surgery) because of the presence of the infraoptic course ACA.

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

BACKGROUND

While variation within the anterior cerebrovascular circulation is common, an infraoptic course of the proximal anterior cerebral artery (ACA), or infraoptic A1, is a relatively rare cerebrovascular anomaly. Associations with suprasellar neoplasms may occur, and accurate identification of this aberrant vessel during dissection is crucial to preventing vascular injury or stroke.

CASE DESCRIPTION

We present the first reported case of surgically confirmed bilateral infraoptic A1 arteries associated with a craniopharyngioma. We review the relevant magnetic resonance imaging (MRI), angiographic, and intraoperative anatomic features of the infraoptic A1 to emphasize the importance of these variables when planning and performing surgery in the region of the anterior communicating artery (AComm) complex.

CONCLUSIONS

Awareness of the existence and clinical significance of this unusual anomaly can facilitate its recognition on preoperative studies and during dissection in the suprasellar space, allowing neurosurgeons to adjust operative plans accordingly.