Surgical and radiologic anatomy : SRA · 2025
Combination of three rare arterial variations: accessory posterior cerebral artery supplying parieto-occipital branch, duplicate origin of the middle cerebral artery, and accessory anterior cerebral artery (ACA) arising from X-shaped ACA diagnosed by magnetic resonance angiography.
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Uchino Akira, Andoh Shunpei
Аннотация
PURPOSE: To describe a case of three rare cerebral arterial variations: (1) accessory posterior cerebral artery (PCA), (2) duplicate origin of the middle cerebral artery (MCA), and (3) accessory anterior cerebral artery (ACA) diagnosed by magnetic resonance angiography (MRA).
METHODS: An 80-year-old man with complete right hemiplegia underwent cranial magnetic resonance imaging (MRI) and MRA using a 3-Tesla scanner. MRA was performed using a standard three-dimensional time-of-flight technique.
RESULTS: MRI revealed acute infarction of the left frontal lobe. MRA showed occlusion of the anterior branch of the left MCA. Subsequently, transarterial thrombectomy was performed. Six days later, follow-up MRA was performed, and a well-recanalized left MCA was confirmed. In addition, accessory right PCA supplying the parieto-occipital branch of the PCA, duplicate origin of the right MCA, and accessory ACA arising from X-shaped ACA, which is an absent variation of the anterior communicating artery (ACoA), were confirmed.
CONCLUSION: An accessory PCA, which typically supplies the temporal branch of the PCA, usually arises from the ACoA. We diagnosed the first case of a combination of three rare cerebral arterial variations. Careful observation using MRA is important for the detection of rare arterial variations. Volume-rendering MRA images are useful for identifying superimposed arteries.
METHODS: An 80-year-old man with complete right hemiplegia underwent cranial magnetic resonance imaging (MRI) and MRA using a 3-Tesla scanner. MRA was performed using a standard three-dimensional time-of-flight technique.
RESULTS: MRI revealed acute infarction of the left frontal lobe. MRA showed occlusion of the anterior branch of the left MCA. Subsequently, transarterial thrombectomy was performed. Six days later, follow-up MRA was performed, and a well-recanalized left MCA was confirmed. In addition, accessory right PCA supplying the parieto-occipital branch of the PCA, duplicate origin of the right MCA, and accessory ACA arising from X-shaped ACA, which is an absent variation of the anterior communicating artery (ACoA), were confirmed.
CONCLUSION: An accessory PCA, which typically supplies the temporal branch of the PCA, usually arises from the ACoA. We diagnosed the first case of a combination of three rare cerebral arterial variations. Careful observation using MRA is important for the detection of rare arterial variations. Volume-rendering MRA images are useful for identifying superimposed arteries.