Abstract
Purpose
Replaced posterior cerebral artery (PCA), defined as a hyperplastic anterior choroidal artery (AChA) supplying all branches of the PCA, is an extremely rare anatomical variation. To the best of our knowledge, there are only a few reports of replaced PCA.
Methods
Herein, we report a case of replaced PCA diagnosed by digital subtraction angiography.
Results
A 76-year-old woman visited a neurosurgical clinic because of headache and vertigo. Magnetic resonance imaging and magnetic resonance angiography incidentally revealed a left internal carotid artery aneurysm. She was referred to our hospital for further examination and treatment of the unruptured intracranial aneurysm. Left internal carotid angiography revealed a paraclinoid aneurysm. We also incidentally found an anomalous hyperplastic AChA distal to the aneurysm. This hyperplastic AChA supplied not only the AChA territory but also the entire PCA territory. No vessels that could be a normal AChA or posterior communicating artery were identified along the left internal carotid artery. Vertebral angiography demonstrated that the left PCA was not visualized. With these findings, we diagnosed anomalous hyperplastic AChoA in this case as replaced PCA.
Conclusion
Careful imaging assessment is important to identify replaced PCA. Both direct findings of a hyperplastic AChA course and perfusion territory and indirect findings of the absence of the original PCA are useful in the diagnosis of replaced PCA.
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All data generated or analyzed during this study are included in this published article.
Code availability
Not applicable.
Abbreviations
- AChA:
-
Anterior choroidal artery
- DSA:
-
Digital subtraction angiography
- ICA:
-
Internal carotid artery
- PCA:
-
Posterior cerebral artery
- PCoA:
-
Posterior communicating artery
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Acknowledgements
We are grateful to Dr. Taketo Kataoka (Department of Neurosurgery, Sapporo Kojinkai Memorial Hospital, Sapporo, Hokkaido, Japan) for his support. We thank Jane Charbonneau, DVM, from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.
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Hideki Endo: protocol/project development, data collection and management, data analysis, and manuscript writing/editing. Kohei Ishikawa: data analysis and manuscript editing. Hidetoshi Ono: data management, data analysis, and manuscript editing. Kaori Honjo: data collection, data analysis, and manuscript editing. Hirohiko Nakamura: Supervision.
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The authors have no relevant financial or non-financial interests to disclose.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Committee of Nakamura Memorial Hospital (No. 2023111101).
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Endo, H., Ishikawa, K., Ono, H. et al. Replaced posterior cerebral artery. Surg Radiol Anat 46, 299–302 (2024). https://doi.org/10.1007/s00276-023-03294-6
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DOI: https://doi.org/10.1007/s00276-023-03294-6