Fetal-type Posterior Cerebral Artery Research Articles

Rare simultaneous fetal posterior cerebral artery and conventional posterior cerebral artery duplication in a patient with a ruptured posterior communicating artery aneurysm: illustrative case.

The fetal-type posterior cerebral artery (PCA) is defined as a variant anatomy in which the posterior communicating artery (PCOM) is larger than the hypoplastic or aplastic P1 segment of the PCA. The authors present the novel case of a patient with a duplicated right PCA in parallel with fetal-type and conventional PCAs supplying adjacent components of the PCA cerebral territory. A 59-year-old woman presented with a modified Fisher Scale score 4 subarachnoid hemorrhage. A right irregular PCOM aneurysm that measured 9.5 mm × 4.5 mm × 4.5 mm arose from the base of a variant branch supplying a portion of the PCA, rather than a conventional PCOM, and was found on digital subtraction angiography. Following endovascular coil embolization, the patient was discharged home. The fetal-type variant has implications for thromboembolic events. If an embolism occludes the anterior circulation in a patient with a fetal-type PCA, it may result in an infarct in the PCA territory. Awareness of cerebral arterial anatomy, including an atypical collateral supply, informs a treating team's latitude in tolerance of which sites must be preserved and which can be safely sacrificed. https://thejns.org/doi/10.3171/CASE23735.

Psoriasiform Drug Eruption AsNeuro-Behçet’s Disease Presenting with Acute Psychosis: A Case Reportsociated with Carbamazepine

The fetal-type posterior cerebral artery (FTPCA) denotes an anomaly within the posterior cerebral circulation, characterized by the distal segment of the posterior cerebral artery (PCA) being supplied by a branch originating from the internal carotid artery (ICA) through the fetal posterior communicating artery (fetal PCOM). The presence of a fetal posterior communicating artery represents a recognized variation within the cerebral vascular anatomy, observed in 4-29% of individuals. This variant may pose distinct challenges in both the detection and management of cerebrovascular conditions or strokes. We report a 60-year-old man who presented with sudden onset left sided weakness and aphasia. A brain CT scan was performed, revealing a right posterior and middle cerebral arteries territories infarct with bilateral fetal-type posterior communicating arteries. CTA brain is commonly done in ischemic stroke cases to assess presence of large vessel occlusions and intracranial or extracranial atherosclerotic disease. However, this case depicts its additional role in detecting anatomical variants of cerebral circulation. In terms of clinical importance, presence of multiple territories infarction portends a poorer neurological outcome.

Circulus Willis Anomalies Diagnosed with CT Angiography and Evaluation of Their Relations with Ischemic Stroke

Our aim in this study is examining the frequency of posterior communicating artery (PCoM), Anterior Cerebral Artery A1 segment (ACA AI) and Fetal type posterior cerebral artery (FPCA) anomalies and their effects on ischemic stroke by retrospectively analyzing examinations of Computerized Tomography Angiography (CTA) taken in our hospital within 2017. 22 cases (26.5%) diagnosed with bilateral hypoplastic / aplastic PCoA anomaly, were diagnosed with anterior circulation infarct, 24 cases (28.9%) were diagnosed with posterior circulation infarct, but 37 cases (44.6%) were not diagnosed with ischemic stroke. 17 (37.8%) of the cases who have unilateral hypoplastic / aplastic PCoA anomaly, were diagnosed with anterior circulation infarct, 14 cases (31.1%) were diagnosed with posterior circulation infarct. 13 (26%) of 50 cases diagnosed with unilateral hypoplastic / aplastic ACA A1 segment, were diagnosed with anterior circulation infarct, 10 cases (20%) were diagnosed with posterior circulation infarct. 27 cases (54%) were not diagnosed with ischemic stroke. Both of 2 cases diagnosed with bilateral hypoplastic / aplastic ACA A1 segment, had anterior circulation infarct. 4 (30.8%) of 13 cases diagnosed with unilateral FPCA anomaly, were diagnosed with anterior circulation infarct, 3 cases (23.1%) were diagnosed with posterior circulation infarct, 6 cases (46.2%) did not have ischemic stroke symptoms. In conclusion, even though these variations’ role in optimum stroke prophylaxis in individuals having one or more stroke risk factors, has not determined yet, there is no doubt that clinical researcher will eliminate these uncertainties in future studies.

Association between the fetal-type posterior cerebral artery and intracranial anterior and posterior circulating atherosclerotic plaques using multi-contrast magnetic resonance vessel wall imaging.

Intracranial atherosclerotic disease (ICAD) is one of the most common causes of ischemic stroke. The fetal-type posterior cerebral artery (FTP) affects intracranial collateral circulation, which is closely related to the occurrence and development of ICAD. Knowledge of the relationship between FTP and ICAD is important for developing treatment strategies for FTP patients diagnosed with atherosclerotic diseases. This study aims to quantitatively analyze the association between the FTP and intracranial atherosclerotic plaques using magnetic resonance vessel wall imaging (VW-MRI). This retrospective study enrolled patients with recent cerebrovascular symptoms (stroke or transient ischemic attack <2 weeks) who were diagnosed with atherosclerotic plaque(s) by VW-MRI in one hospital from October 2018 to March 2022. They were classified into the FTP group and the non-FTP group. Plaque characteristics and vascular-related parameters in intracranial arteries were compared between the two groups. Univariate and multivariate logistic regressions were performed to determine the odds ratios (ORs) and corresponding 95% confidence intervals (CIs) of the plaque characteristics between the two groups. A total of 104 patients (mean age: 61.8±9.8 years, 57 males) were included for VW-MRI scan analysis. 40 (38.46%) and 64 (61.54%) were classified into the FTP and the non-FTP groups, respectively. The plaques of middle cerebral artery (MCA) in the FTP group were more likely to occur on the dorsal and superior walls of the lumen compared with the non-FTP group (37.50% vs. 17.19%, P=0.001). The remodeling index (RI) of MCA was statistically different between the two groups (1.071±0.267 vs. 0.886±0.235, P=0.007). No significant differences were found in vertebrobasilar artery (VBA) plaque distributions (17.50% vs. 9.38%, 10.00% vs. 12.50%, 20.00% vs. 17.19%, P>0.05) and characteristics between the two groups (RI: 1.095±0.355 vs. 0.978±0.251; eccentricity index: 0.539±1.622 vs. 0.550±0.171, P>0.05). The plaques in the FTP group were more likely to occur on the dorsal and superior walls of the MCA, and the presentence of FTP was found to be significantly correlated with vascular remodeling of MCA atherosclerotic plaques. The relationship between the severity of intracranial atherosclerosis and the presence of FTP can provide valuable information for clinicians to intervene early and prevent the occurrence of stroke.

Hemodynamic differences of posterior communicating artery aneurysms between adult and fetal types of posterior cerebral artery.

The recanalization of posterior communicating artery (PCoA) aneurysms after endovascular treatment has been analyzed by various factors. However, the differences between adult and fetal types of posterior cerebral artery (PCA) have not been fully investigated. The main aim of this study was to investigate hemodynamic differences of PCoA aneurysms between adult and fetal types using computational fluid dynamics (CFD). Fifty-five PCoA aneurysms were evaluated by 3D CT angiography and divided into unruptured aneurysms with adult-type or fetal-type PCAs (19 cases, UA group; 9 cases, UF group) and ruptured aneurysms with adult-type or fetal-type PCAs (17 cases, RA group; 10 cases, RF group). These native aneurysms were analyzed by CFD regarding morphological and hemodynamic characteristics. To evaluate simulated endovascular treatment of aneurysms, CFD was performed using porous media modeling. Morphologically, the RA group had significantly smaller parent artery diameter (2.91 mm vs. 3.49 mm, p=0.005) and higher size ratio (2.54 vs. 1.78, p=0.023) than the RF group. CFD revealed that the UA group had significantly lower oscillatory shear index (OSI) (0.0032 vs. 0.0078, p=0.004) than the UF group and that the RA group had lower WSS (3.09 vs. 11.10, p=0.001) and higher OSI (0.014 vs. 0.006, p=0.031) than the RF group, while the RF group presented significantly higher intra-aneurysmal flow velocity (0.19 m/s vs. 0.061 m/s, p=0.002) than the RA group. Porous media modeling of simulated treatment revealed higher residual flow volume in the fetal-type groups. These results suggested that PCoA aneurysms with fetal-type PCAs had different morphological features and hemodynamic characteristics compared with those with adult-type PCAs, leading to high risks of recanalization.

Hemorrhage Risk in Moyamoya Disease with Fetal-Type Posterior Cerebral Artery: A Propensity Score-Matched Analysis

Patients with moyamoya disease (MMD) and fetal-type posterior cerebral arteries have not been thoroughly investigated as yet. We focused on the risk of intracranial hemorrhage in patients with MMD and fetal-type posterior cerebral arteries. We reviewed 2422 patients with MMD diagnosed at the Neurosurgical Department of Beijing Tiantan Hospital between May 2009 and December 2020. We classified patients into 2 groups according to whetherthey had a fetal-type posterior cerebral artery. After 1:1 propensity score matching, hemorrhagic tendencyand Suzuki stage were compared between patients with a fetal-type posterior cerebral artery (group I) and patients without a fetal-type posterior cerebral artery (group II). In total, 2415 patients were included in this study; 181 had fetal-type posterior cerebral arteries. Hemorrhagic events were more frequently observed in patients with fetal-type posterior cerebral artery development than in those without it (28.2% vs. 18.8%, P=0.035). However, Suzuki stages did not differ between the 2 matched groups (4.03 vs. 4.20, P= 0.081). Hemorrhagic events occurred more frequently in patients with MMD with fetal-type posterior cerebral arteries than in those without.

An anatomical study of persistent trigeminal artery detected by computed tomography angiography and magnetic resonance angiography: proposal for a modified classification and a novel basilar artery grading system.

The purpose of this study is to investigate the anatomical characteristics of persistent trigeminal artery (PTA) detected by computed tomography angiography (CTA) and magnetic resonance angiography (MRA), propose a modified classification and a novel grading system for basilar artery (BA). Patients who underwent head CTA or MRA in our hospital between August 2014 and August 2022 were reviewed retrospectively. The prevalence, sex, and course of PTA were evaluated. PTA types were modified based on Weon's classification. Type I to IV were similar to those in Weon's classification except the presence of intermed fetal-type posterior cerebral artery (IF-PCA). Type V was the same as that in Weon's classification. Type VI included subtypes of VIa (concomitant IF-PCA based on type I to IV) and VIb (other variants). BA was assessed based on a scale of 0 to 5 compared with PTA's caliber (0, BA aplasia; 1 and 2, BA non-dominant; 3, equilibrium; 4 and 5, BA dominant). A total of 57 patients (0.06%) with PTA, including 36 females and 21 males, were detected in 94,487 patients. Six patients (10.5%) were medial type and 51 patients (89.5%) were lateral type. Thirty-seven patients (64.9%) were type I, 1 (1.8%) as type II, 13 (22.8%) as type III, 3 (5.3%) as type IV, 1 (1.8%) as type V, and 2 (3.5%) as type VI. For BA grading, 4 (7.0%), 21 (36.8%), 17 (29.8%), 6 (10.5%), 6 (10.5%), and 3 (5.3%) of the patients were grade 0, 1, 2, 3, 4, and 5, respectively. Fifteen patients (26.3%) had intracranial aneurysms. One cases (1.8%) had a fenestration of the PTA. The prevalence of PTA in our study was lower than that in most previous reports. The modified PTA classification and BA grading system can be used to better understand the vascular structure of PTA patients.

Is Fetal-Type Posterior Cerebral Artery a Risk Factor for Recurrence in Coiled Internal Carotid Artery-Incorporating Posterior Communicating Artery Aneurysms? Analysis of Conventional Statistics, Computational Fluid Dynamics, and Random Forest With Hyper-Ensemble Approach.

The fetal-type posterior cerebral artery (FPCA) has been regarded as the risk factor for recurrence in coiled internal carotid artery-incorporating posterior communicating artery (ICA-PCoA) aneurysm. However, it has not been proven in previous literature studies. To reveal the impact of FPCA on the recurrence of ICA-PCoA aneurysms using conventional statistical analysis, computational fluid dynamics (CFD) simulation, and random forest with hyper-ensemble approach (RF with HEA). Vascular parameters and clinical information from patients who underwent coil embolization ICA-PCoA aneurysms from January 2011 to December 2016 were obtained. Conventional statistical analysis was applied to a total of 95 cases obtained from patients with a follow-up of more than 6 months. For CFD simulation, 3 sets of three-dimensional models were used to understand the hemodynamical characteristics of various FPCAs. The RF with HEA was applied to reinforce the clinical data analysis. The conventional statistical analysis fails to reveal that FPCA is a risk factor. CFD analysis shows that the diameter of FPCA alone is less likely to be a risk factor. The RF with HEA shows that the impact of FPCA is also minor compared with that of the packing density in the recurrence of coiled ICA-PCoA aneurysms. The gathered results of all 3 analyses show more clear evidence that FPCA is not a risk factor for coiled ICA-PCoA aneurysms. Hence, we may conclude that FPCA itself is doubtful to be the major risk factor in the recurrence of coiled ICA-PCoA aneurysms.

Spontaneous thrombolysis of an unruptured intracranial aneurysm with spontaneous thrombosis

Background: Spontaneous thrombolysis of unruptured intracranial aneurysm with spontaneous thrombosis is rare and its significance remains unclear. To date, there are no published reports of spontaneous thrombolysis prior to growth of unruptured intracranial aneurysm with spontaneous thrombosis. Methods: We described a 65-year-old man with a chief complaint of mild weakness and numbness in the left limbs. He had a smoking history of 20 years. Then he was diagnosed having unruptured intracranial aneurysm with spontaneous thrombosis. His cerebrovascular digital subtraction angiography conducted 30 days after his first onset revealed spontaneous thrombolysis of the unruptured intracranial aneurysm. And his following brain computed tomography scan conducted 36 days after his first onset revealed growth of the unruptured intracranial aneurysm. Results: The diagnosis of unruptured right fetal-type posterior cerebral artery aneurysm with spontaneous complete thrombosis was established based on the preliminary physical examination and the imaging findings. The patient underwent embolization of the aneurysm and parent artery. We followed up with the patient for 12 months after his embolization of the aneurysm and parent artery. He experienced neither aneurysm recurrence nor cerebral infarction during this period, but his were not alleviated. Conclusion: Spontaneous thrombolysis after spontaneous thrombosis of unruptured intracranial aneurysm is an urgent indication for isolation of the aneurysm, as it may foreshadow the growth of unruptured intracranial aneurysm.

Double-Balloon-Assisted Coiling for Wide-Necked Posterior Communicating Artery Aneurysms with a Fetal-Type Variant of the Posterior Cerebral Artery: A Case Series.

Endovascular treatment for wide-necked posterior communicating artery (PcomA) aneurysms with a fetal-type variant of the posterior cerebral artery (PCA) is often challenging. Since the complete occlusion rates achieved with the currently available treatment methods are unsatisfactory, we aimed to study the effectiveness of a double-balloon-assisted technique for these aneurysms. From September 2014 to August 2020, 6 consecutive patients with PcomA aneurysms with fetal-type PCAs and no previous treatment were treated with this technique at our institution (3 ruptured cases and 3 unruptured cases). The indication for this technique is that the neck of the aneurysm should significantly and broadly incorporate both the internal carotid artery and fetal-type PCA, such that a single-balloon remodeling and single stent would be inadequate to protect both the arteries. In all patients, the fetal-type PCAs were preserved without a stent and with adequate occlusion status. This double-balloon technique can be effective in the treatment of these aneurysms.

Mechanisms of Stroke in Patients with Fetal Posterior Cerebral Artery

ObjectivesThe fetal-type posterior cerebral artery (FTP) is a normal variation of the posterior cerebral artery (PCA), occurring in 3–36% of general population. The effects of the FTP in stroke mechanisms remain debatable. We aimed to investigate the differences in stroke mechanisms and lesion locations between patients with and without FTP. MethodsA total of 394 patients with PCA territory stroke were divided into those with PCA ischemic stroke associated with ipsilateral FTP and those without. The baseline characteristics, vascular risk factors, infarct pattern, stroke location, stroke etiology, and the diameter of P1 in patients without FTP or posterior communicating artery (PcoA) in patients with FTP were investigated. ResultsAmong the 394 patients, 52 (13.2%) PCA stroke patients with ipsilateral FTP were enrolled. Patients with FTP, in comparison with those without, had a higher frequency of deep infarct pattern (69.2% vs. 47.1%, P=0.012), small vessel occlusion (51.9% vs. 28.9%, P=0.009), ventrolateral thalamic involvement (65.4% vs. 49.1%, P=0.042), and a lower frequency of cardiac embolism (9.6% vs. 24.0%, P=0.009). The diameter of P1 in patients without FTP was larger than that of PcoA in patients with FTP (2.1 ± 0.3 mm vs. 1.6 ± 0.2 mm, P <0.001). ConclusionsThe stroke mechanisms, infarct pattern, and the location of the stroke were different between patients with and without FTP. PCA stroke patients with FTP more often had small vessel occlusion and ventrolateral thalamic involvement. These results are probably associated with difference in the hemodynamic status according to the presence of FTP.

The Association between Migraine and Fetal-Type Posterior Cerebral Artery in Patients with Ischemic Stroke

Objective: The aim of the study was to determine if migraine is associated with fetal-type posterior cerebral artery (PCA) in patients with ischemic stroke. Method: In this cross-sectional study, patients with acute ischemic stroke were enrolled from two hospitals. The history of migraine headache was evaluated during a face-to-face interview. The variants of fetal-type PCA were assessed with MRA, CTA, or DSA. Patients with and without migraine were compared in terms of fetal-type PCA status and other clinic characteristics. Multivariate logistic regression analyses were performed to adjust for confounders and provide risk estimates for observed associations. Result: In 750 patients qualified for analysis, 85 (11.3%) were determined with migraine. Patients with migraine had a higher proportion of female gender (51.8% vs. 31.0%, p < 0.001), hypertension (72.9% vs. 57.7%, p = 0.007), and fetal-type PCA (36.5% vs. 20.1%, p = 0.001), while lower proportion of current smoking (25.9% vs. 38.3%, p = 0.025) than patients without migraine. National Institutes of Health Stroke Scale (NIHSS) score (3 vs. 2, p = 0.016) was also higher in migraineurs than in non-migraineurs. After adjustment for confounders, fetal-type PCA status was independently associated with migraine (odds ratio [OR] = 2.06; 95% confidence interval [CI], 1.25–3.38; p = 0.005). Other factors associated to migraine included female gender (OR = 2.03; 95% CI, 1.13–3.62; p = 0.017), hypertension (OR = 1.97; 95% CI, 1.17–3.34; p = 0.011), and NIHSS score (OR = 1.08; 95% CI, 1.01–1.16; p = 0.018). Conclusion: Migraine was associated with fetal-type PCA in patients with ischemic stroke. This finding supported the hypothesis that vascular mechanisms get involved in the migraine-stroke association.

Validation of an Oscillation Test for the Sonographic Assessment of Fetal-Type Posterior Cerebral Artery Variants in Migraine Patients with Visual Aura.

Anatomic variants of the posterior circle of Willis, including the fetal-type posterior cerebral artery (FPCA), may contribute to the formation of visual aura in migraine. We sought to validate an oscillation test to investigate FPCA frequency in migraine using transcranial color-coded duplex ultrasonography (TCCS). First, the diagnostic accuracy of the oscillation test used to identify FPCA variants by TCCS was assessed in stroke patients with available computed tomography angiography (CTA) as the set gold standard. Second, in a cross-sectional study, patients with migraine with visual aura (MWVA) and migraine without aura (MWOA), as well as healthy controls, were prospectively recruited for sonographic assessment of FPCA variants. We compared FPCA frequency between migraine patients and controls using χ2-testing and performed logistic regression analysis to investigate a potential association between MWVA and the presence of FPCA variants. Specificity, sensitivity and positive and negative predictive values for sonographic identification of FPCA with CTA as the set gold standard were 93%, 77%, 63% and 96% (partial FPCA) and 99%, 78%, 88% and 98% (complete FPCA), respectively. One hundred forty-two migraine patients (39 ± 12 y, 90 MWVA and 52 MWOA) and 49 healthy controls (31 ± 12 y) were recruited. The χ2 testing did not reveal significant differences in FPCA frequency as assessed by TCCS (unilateral or bilateral, partial and/or complete) between migraine patients and controls (MWVA: 40/90 or 44.4%, MWOA: 22/52 or 42.3%, controls: 24/49 or 49%, p=0.79). Similarly, the frequencies of partial FPCA (p=0.61) and complete FPCA (p=0.27) did not vary significantly among groups. Logistic regression analysis revealed no interaction effect between migraine diagnosis and FPCA prevalence (any FPCA), when adjusted for age and sex. The sonographic oscillation test can be used as a non-invasive method to identify partial and complete FPCA variants with high specificity and reasonable sensitivity. Our findings suggest that FPCA variants do not contribute to the formation of visual migraine aura.

Morphometric analysis of normal and variant anatomy of posterior cerebral artery and the incidence of fetal posterior cerebral artery in Uttar Pradesh region: A computed tomography angiographic study

Introduction: The aim is to study morphometric analysis of normal and variant anatomy of posterior cerebral artery (PCA) and incidence of fetal PCA (FPCA) in Uttar Pradesh region. The PCA and its cortical branches supply blood to the occipital lobe, inferomedial temporal lobe, and portions of posterior inferior parietal lobe. Fetal-type PCA is a common anatomic variation of PCA that is closely associated with intracranial aneurysm. The present study provides the description of PCA regarding its normal morphology, morphometry, and variations in Uttar Pradesh region. Material and Methods: The study evaluated 100 computed tomography angiograms. Results: Among arteries that displayed normal anatomy, mean diameter of PCA was observed to be 4.29 ± 0.74 mm on the right side and 2.47 ± 0.74 mm on the left side. Mean diameter in males and in females was found to be 2.48 ± 0.73 mm and 2.47 ± 0.74 mm, respectively. In 56.5% of cases, the diameters of P1 segment of PCAs ranged from 2.1 to 3 mm whereas >3 mm diameter was observed in 18.5% cases. Nineteen percent cases showed 1.1–2 mm. In 6% cases, hypoplasia (≤1 mm) of PCA was observed. FPCA was observed in 26% cases. Unilateral observed in 17% cases and bilateral in 9% cases and the difference was statistically significant (P < 0.000). Discussion and Conclusion: Anomalies of PCA may assume considerable significance in surgeries of head and neck, which require ligation of internal carotid and common carotid artery. Awareness of these anatomical variations described shall prove to be useful for any cerebrovascular procedures.

Fetal posterior communicating artery as a conduit for concurrent anterior and posterior circulation infarct: A case report

Fetal type posterior cerebral artery (FTPCA) is a variant of posterior circulation of brain, in which the distal part of posterior cerebral artery (PCA) is perfused by a branch of internal carotid artery (ICA) via fetal posterior communicating artery (fetal PCOM). In the presence of fetal PCOM, a paradoxical concurrent infarction of anterior and posterior circulation may happen. We report a 67-year-old man who presented with sudden onset right sided weakness and aphasia, with National Institutes of Health Stroke Scale (NIHSS) score of 22 and clinically diagnosed to have left total anterior circulation infarct (TACI). Subsequently, he received IV Alteplase as a standard hyperacute ischemic stroke treatment. Computed tomography angiography (CTA) of brain showed left FTPCA with prominent left fetal PCOM. Subsequent computed tomography (CT) of brain showed concurrent left middle cerebral artery (MCA) and PCA territories infarct. CTA brain is commonly done in ischemic stroke cases to assess presence of large vessel occlusions and intracranial or extracranial atherosclerotic disease. However, this case depicts its additional role in detecting anatomical variants of cerebral circulation. In terms of clinical importance, presence of multiple territories infarction portends a poorer neurological outcome.

Performance of rupture-related morphological parameters in posterior communicating artery aneurysms with fetal-type variant.

The aim of the study was to investigate the impact of fetal-type posterior cerebral artery (fPCA) variant on morphological parameters of posterior communicating artery (PComA) aneurysms for rupture risk assessment. A total of 98 PComA aneurysms (62 ruptured and 36 unruptured) in 98 consecutive patients were reviewed. Morphological parameters were calculated including aneurysm size, aspect ratio (AR), size ratio (SR), dome-to-neck ratio, bottleneck factor and inflow angle. Performances of morphological parameters to discriminate rupture status were compared between aneurysms with or without fPCA. Fetal-type posterior cerebral artery variant was determined in 39 (39.8%, 25 ruptured and 14 unruptured) lesions. The ruptured group revealed a significantly larger size (p = 0.004), AR (p = 0.003), SR (p = 0.001), and inflow angle (p < 0.001). For the aneurysms without fPCA, all morphological parameters were significantly different between ruptured and unruptured aneurysms (p < 0.05); for the aneurysms with fPCA, only inflow angle (p = 0.001) was significantly related with the rupture status. Multivariate analysis showed that SR (p = 0.035 and p = 0.011) and inflow angle (p = 0.001 and p = 0.028) were independent rupture risk factors for the total cohort and the aneurysms without fPCA; while only inflow angle (p = 0.004) revealed to be independently related with rupture status of aneurysms without fPCA. The performances of morphological parameters to discriminate rupture status were different between PComA aneurysms with and without fPCA variants. Inflow angle might be a reliable predictor for rupture risk of PComA aneurysms.

Risk Factors for the Recurrence of Posterior Communicating Artery Aneurysm: The Significance of Fetal-Type Posterior Cerebral artery

ObjectivesThe purpose of this study was to investigate the risk factors associated with recurrence of posterior communicating artery aneurysms after treatment and to evaluate the significance of fetal-type posterior cerebral artery as an independent risk factor for recurrence of posterior communicating artery aneurysms. Materials and methodsThe clinical and radiological findings of 220 posterior communicating artery aneurysms treated between January 2009 and December 2016 in a single tertiary institute were retrospectively reviewed. Univariate and multivariate analyses were performed to evaluate the association between clinical and radiological variables and recurrence. ResultsOf 220 posterior communicating artery aneurysms, 148 aneurysms were unruptured and 82 aneurysms were treated with surgery. Forty-six out of 220 aneurysms (20.9%) were associated with fetal-type posterior cerebral artery. Overall recurrence rate was 19% (42 out of 220 aneurysms) during mean 54.6 ± 29.8 months follow-up. Multivariate logistic regression analysis showed that size (OR=1.238; 95% CI, 1.087–1.409, p = 0.001), ruptured status (OR=2.699; 95% CI, 1.179–6.117, p = 0.019), endovascular treatment (OR=3.803; 95% CI, 1.330–10.875, p = 0.013), incomplete occlusion (OR=4.699; 95% CI, 1.999–11.048, p = <0.001) and fetal-type posterior cerebral artery (OR=3.533; 95% CI, 1.373–9.089, p = 0.009) were significantly associated with recurrence after treatment. ConclusionsThe results demonstrated that fetal-type posterior cerebral artery may be an independent risk factor for the recurrence of posterior communicating artery aneurysms. Therefore, fetal-type posterior cerebral artery can be considered as an important risk factor for the recurrence of posterior communicating artery aneurysms, along with other known risk factors such as size, ruptured status, endovascular treatment, and incomplete occlusion.

Transcirculation Silk Vista Baby-assisted coiling in half-T configuration for the treatment of posterior communicating artery aneurysms associated with a fetal posterior circulation: An alternative flow diversion strategy.

Flow diverter devices have become a routine first-line option for treatment of an increasing population of intracranial aneurysms at many neurovascular centers. Despite the promising results of flow diverter stents on anterior circulation, incomplete occlusion on the presence of fetal posterior circulation has been described on several reports. Here we describe a novel technical alternative to conventional flow diversion approach for this specific subgroup of aneurysms using the low-profile flow diverter, Silk Vista Baby. The device was selectively placed into the fetal type posterior cerebral artery in half-T configuration for the treatment of a posterior communicating aneurysm using a transcirculation approach through the anterior communicating artery. This represents a useful and effective technique and should be considered when encountering the above-described situation.

Impact of fetal-type posterior cerebral artery on recanalization of posterior communicating artery aneurysms after coil embolization: matched-pair case–control study

BackgroundIt is well known that hemodynamic stress may impact the recanalization of coiled aneurysms. One of the most common sites for aneurysms to develop is the posterior communicating artery (PcoA),...

Human basilar artery: morphology &amp;amp; variations

<sec> Introduction Basilar artery is an unpaired medium-sized artery formed by the confluence of right and left vertebral arteries at the pontomedullary junction and extends to the pontomesencephalic junction. It forms the spine of posterior cerebral circulation which is constituted by the vertebrobasilar system and its branches. Normal morphology of the basilar artery forms an essential component of cerebral circulation. The present study aims to measure the level of formation &amp; termination, length, diameter, and angle of formation of the basilar artery. The data presented are relevant to understanding human variations and would be a good anatomical reference for clinicians, anatomists, and medical students. Caliber, length, and angle of bifurcation of the basilar artery help in assessing the feasibility and approach for various surgical procedures and predict cerebro-vascular diseases. </sec><sec> Materials &amp; methods 96 adult human brain specimens were studied. (78 male, 18 female) (Age range: 19–80 y; Average age: 47.66 y). Measurements were taken using Vernier calliper. Data was analysed using Microsoft Excel and SPSS software version 17. </sec><sec> Results The basilar artery was formed by the confluence of two vertebral arteries in all specimens extending from the pontomedullary junction to the pontomesencephalic junction in 2/3^rd of the cases. The left vertebral artery was found to be dominant in 62.5% specimens. The basilar artery showed an average length of 3.1 cm (demonstrating positive correlation with age), average diameter of 3.6–3.9 mm at different levels, and average angle of formation as 65.38° in males and 62.22° in females. Fetal type posterior cerebral artery was noticed in 9.4% cases. 3.1% and 6.3% cases were seen on the right and left sides respectively. Basilar artery fenestration was noted in 2 percent specimens. </sec><sec> Conclusion Basilar artery morphology was studied in 96 human adult cadavers. Basilar artery formation and termination was normal in more than 2/3^rd cases. Variations were noted in its origin, vessel hypoplasia, presence of fenestrations, and fetal patterns. The data obtained from this study are relevant for anatomists, medical students, interventional radiologists, and neurosurgeons. </sec>