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An MRI study of typical anatomical variants of the anterior communicating artery complex

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Abstract

Purpose

This magnetic resonance imaging study examined the most frequent anatomical variants of the anterior communicating artery (ACoA) complex of the cerebral arterial circle, and aimed to determine whether they were associated with ACoA complex aneurysm.

Methods

The study enrolled 669 patients. Using three-dimensional time-of-flight magnetic resonance angiography, 617 patients were classified into the following groups based on the anatomical variation in the ACoA complex: no ACoA complex anomaly; ACoA complex aneurysm; and vascular anomaly distant from the cerebral arterial circle.

Results

Of the 617 classified subjects, the classical anatomical description applied to 48.73% in the no ACoA complex anomaly group and 37.5% in the ACoA complex aneurysm group. One variant (left anterior cerebral artery segment A1 hypoplasia) was significantly more frequent in the ACoA complex aneurysm group. There was no sex difference in the prevalence of any variant.

Conclusions

Anatomical variants of the ACoA complex of the cerebral arterial circle were found in almost half of the subjects. One variant seemed to be associated with a higher likelihood of an aneurysm, but causality could not be inferred.

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References

  1. Ahlqvist J (2001) Stress-related intracerebral hemorrhage and the water-hammer effect. Stroke 32:275–278. https://doi.org/10.1161/01.STR.32.1.275-a

    Article  CAS  PubMed  Google Scholar 

  2. Damşa T, Appel E, Cristidis V (1976) “Blood-hammer” phenomenon in cerebral hemodynamics. Math Biosci 29:193–202. https://doi.org/10.1016/0025-5564(76)90102-4

    Article  Google Scholar 

  3. Ding R, Xu X, Guan D, Zhu B, Zhang G, Wu X (2019) Fatal subarachnoid hemorrhage caused by rupture of variant anterior communicating artery: a case report and literature review. Forensic Sci Med Pathol 15:97–101. https://doi.org/10.1007/s12024-018-0042-3

    Article  PubMed  Google Scholar 

  4. Hannequin P, Peltier J, Destrieux C, Velut S, Havet E, Le Gars D (2013) The inter-optic course of a unique precommunicating anterior cerebral artery with aberrant origin of an ophthalmic artery: an anatomic case report. Surg Radiol Anat 35:269–271. https://doi.org/10.1007/s00276-012-1028-6

    Article  PubMed  Google Scholar 

  5. Iqbal S (2013) A comprehensive study of the anatomical variations of the circle of willis in adult human brains. J Clin Diagn Res 7:2423–2427. https://doi.org/10.7860/JCDR/2013/6580.3563

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Jiménez-Sosa M, Cantu-Gonzalez J, Morales-Avalos R, Garza-Castro O, Quiroga-Garza A, Pinales-Razo R, Elizondo G, Elizondo Omaña R, López S (2017) Anatomical variants of anterior cerebral arterial circle: a study by multidetector computerized 3D tomographic angiography. Int J Morphol 35:1121–1128. https://doi.org/10.4067/S0717-95022017000300049

    Article  Google Scholar 

  7. Kamath S (1981) Observations on the length and diameter of vessels forming the circle of Willis. J Anat 133:419–423

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Kawashima M, Endo M, Kitahara T, Soma K, Fujii K (2008) Unusual location of anterior communicating artery aneurysm located on the planum sphenoidale due to long A1 segments. Neurol Med Chir (Tokyo) 48:254–256. https://doi.org/10.2176/nmc.48.254

    Article  Google Scholar 

  9. Kayembe KN, Sasahara M, Hazama F (1984) Cerebral aneurysms and variations in the circle of Willis. Stroke 15:846–850. https://doi.org/10.1161/01.str.15.5.846

    Article  CAS  PubMed  Google Scholar 

  10. Kim MS, Sim SY (2016) Infraoptic anterior cerebral artery: case series report and literature review. Surg Radiol Anat 38:887–891. https://doi.org/10.1007/s00276-016-1651-8

    Article  PubMed  Google Scholar 

  11. Krabbe-Hartkamp MJ, van der Grond J, de Leeuw FE, de Groot JC, Algra A, Hillen B, Breteler MM, Mali WP (1998) Circle of Willis: morphologic variation on three-dimensional time-of-flight MR angiograms. Radiology 207:103–111. https://doi.org/10.1148/radiology.207.1.9530305

    Article  CAS  PubMed  Google Scholar 

  12. Krzyzewski RM, Tomaszewska IM, Lorenc N, Kochana M, Goncerz G, Klimek-Piotrowska W, Walocha K, Urbanik A (2014) Variations of the anterior communicating artery complex and occurrence of anterior communicating artery aneurysm: A2 segment consideration. Folia Med Cracov 54:13–20

    PubMed  Google Scholar 

  13. Krzyżewski RM, Tomaszewski KA, Kochana M, Kopeć M, Klimek-Piotrowska W, Walocha JA (2015) Anatomical variations of the anterior communicating artery complex: gender relationship. Surg Radiol Anat 37:81–86. https://doi.org/10.1007/s00276-014-1313-7

    Article  PubMed  Google Scholar 

  14. Leipzig TJ, Morgan J, Horner TG, Payner T, Redelman K, Johnson CS (2005) Analysis of intraoperative rupture in the surgical treatment of 1694 saccular aneurysms. Neurosurgery 56:455–468. https://doi.org/10.1227/01.neu.0000154697.75300.c2 (discussion 455-468)

    Article  PubMed  Google Scholar 

  15. López-Sala P, Alberdi N, Mendigaña M, Bacaicoa M-C, Cabada T (2020) Anatomical variants of anterior communicating artery complex. A study by Computerized Tomographic Angiography. J Clin Neurosci 80:182–187. https://doi.org/10.1016/j.jocn.2020.08.019

    Article  PubMed  Google Scholar 

  16. Mahajan A, Banga V, Chatterjee A, Goel G (2020) 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. Asian J Neurosurg 15:247–249. https://doi.org/10.4103/ajns.AJNS_193_19

    Article  PubMed  PubMed Central  Google Scholar 

  17. Makowicz G, Poniatowska R, Lusawa M (2013) Variants of cerebral arteries—anterior circulation. Pol J Radiol 78:42–47. https://doi.org/10.12659/PJR.889403

    Article  PubMed  PubMed Central  Google Scholar 

  18. Meyer A, Hierons R (1964) A note on Thomas Willis’ views on the corpus striatum and the internal capsule. J Neurol Sci 1:547–554. https://doi.org/10.1016/0022-510X(64)90172-8

    Article  PubMed  Google Scholar 

  19. Ravikanth R, Philip B (2019) Magnetic resonance angiography determined variations in the circle of Willis: analysis of a large series from a single center. Tzu Chi Med J 31:52–59. https://doi.org/10.4103/tcmj.tcmj_167_17

    Article  PubMed Central  Google Scholar 

  20. Rengachary SS, Xavier A, Manjila S, Smerdon U, Parker B, Hadwan S, Guthikonda M (2008) The legendary contributions of Thomas Willis (1621–1675): the arterial circle and beyond. J Neurosurg 109:765–775. https://doi.org/10.3171/JNS/2008/109/10/0765

    Article  PubMed  Google Scholar 

  21. Rinaldo L, McCutcheon BA, Murphy ME, Bydon M, Rabinstein AA, Lanzino G (2017) Relationship of A1 segment hypoplasia to anterior communicating artery aneurysm morphology and risk factors for aneurysm formation. J Neurosurg 127:89–95. https://doi.org/10.3171/2016.7.JNS16736

    Article  PubMed  Google Scholar 

  22. Rossitti S (2015) Letter to the Editor: the blood-hammer effect and aneurysmal basilar artery bifurcation angles. J Neurosurg 122:1512–1513. https://doi.org/10.3171/2014.12.JNS142667

    Article  PubMed  Google Scholar 

  23. Sun L, Wang J, Li M, Li M, Zhu Y (2020) The contribution of wall shear stress insult to the growth of small unruptured cerebral aneurysms in longitudinal 3D-TOF-MRA. J Neurol Sci 413:116798. https://doi.org/10.1016/j.jns.2020.116798

    Article  PubMed  Google Scholar 

  24. Tarulli E, Fox AJ (2010) Potent risk factor for aneurysm formation: termination aneurysms of the anterior communicating artery and detection of A1 vessel asymmetry by flow dilution. AJNR Am J Neuroradiol 31:1186–1191. https://doi.org/10.3174/ajnr.A2065

    Article  PubMed  PubMed Central  Google Scholar 

  25. Turkoglu E, Arat A, Patel N, Kertmen H, Başkaya MK (2011) Anterior communicating artery aneurysm associated with an infraoptic course of anterior cerebral artery and rare variant of the persistent trigeminal artery: a case report and literature review. Clin Neurol Neurosurg 113:335–340. https://doi.org/10.1016/j.clineuro.2010.12.009

    Article  PubMed  Google Scholar 

  26. Uchino A, Nomiyama K, Takase Y, Kudo S (2006) Anterior cerebral artery variations detected by MR angiography. Neuroradiology 48:647–652. https://doi.org/10.1007/s00234-006-0110-3

    Article  PubMed  Google Scholar 

  27. Zhang X, Karuna T, Yao Z-Q, Duan C-Z, Wang X-M, Jiang S-T, Li X-F, Yin J-H, He X-Y, Guo S-Q, Chen Y-C, Liu W-C, Li R, Fan H-Y (2018) High wall shear stress beyond a certain range in the parent artery could predict the risk of anterior communicating artery aneurysm rupture at follow-up. J Neurosurg 131:868–875. https://doi.org/10.3171/2018.4.JNS173179

    Article  PubMed  Google Scholar 

  28. Zhao H, Fu J, Lu Z, Lü H (2009) Fenestration of the anterior cerebral artery detected by magnetic resonance angiography. Chin Med J (Engl) 122:1139–1142

    Google Scholar 

  29. Zurada A, Gielecki J, Tubbs RS, Loukas M, Maksymowicz W, Chlebiej M, Cohen-Gadol AA, Zawiliński J, Nowak D, Michalak M (2011) Detailed 3D-morphometry of the anterior communicating artery: potential clinical and neurosurgical implications. Surg Radiol Anat 33:531–538. https://doi.org/10.1007/s00276-011-0792-z

    Article  PubMed  Google Scholar 

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Acknowledgements

We wish to thank Prof. Aymeric Rouchaud and the Department of Radiology, University Hospital of Limoges, France, for allowing us to access the MRI imaging.

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Authors and Affiliations

  1. Department of Human Anatomy, Laboratoire d’Anatomie, Faculty of Medicine, University of Limoges, 2, rue du Docteur Marcland, 87025, Limoges, France

    Fabien Fredon, Jeremy Hardy, Assia Kouirira, Léa Jamilloux, Christian Mabit, Denis Valleix & Sylvaine Durand-Fontanier

  2. Department of Radiology, Limoges University Hospital, CHU Dupuytren, 2, Avenue Martin-Luther-King, 87000, Limoges, France

    Maxime Baudouin, Aymeric Rouchaud & Sylvaine Durand-Fontanier

  3. University of Limoges, XLIM, UMR CNRS 7252, 87000, Limoges, France

    Abdelkader Taïbi, Aymeric Rouchaud & Sylvaine Durand-Fontanier

  4. Service de Chirurgie Digestive, Générale et Endocrinienne, Centre Hospitalier Universitaire de Limoges, 2 Avenue Martin-Luther King, 87000, Limoges, France

    Fabien Fredon

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  1. Fabien Fredon
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  2. Maxime Baudouin
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  3. Jeremy Hardy
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  8. Denis Valleix
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  9. Aymeric Rouchaud
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  10. Sylvaine Durand-Fontanier
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Contributions

FF, SDF and AR developed the protocol/project. AK, LJ and MB collected the data. FF and AT participated in data analysis. All authors participated in writing, editing, and approval of the final manuscript.

Corresponding author

Correspondence to Fabien Fredon.

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The authors declare no conflicts of interest regarding the publication of this article.

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Fredon, F., Baudouin, M., Hardy, J. et al. An MRI study of typical anatomical variants of the anterior communicating artery complex. Surg Radiol Anat 43, 1983–1988 (2021). https://doi.org/10.1007/s00276-021-02782-x

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