Hemorrhagic events associated with unfused or twig-like configuration of the Middle cerebral artery: A rare vascular anomaly with clinical relevance

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  • Rene Viso
    Departamento de Neuroradiología Intervencionista, Instituto Medico Eneri-Clinica La Sagrada Familia, Buenos Aires, Argentina
  • Ivan Lylyk
    Departamento de Neuroradiología Intervencionista, Instituto Medico Eneri-Clinica La Sagrada Familia, Buenos Aires, Argentina
  • Pablo Albiña
    Departamento de Neurocirugía, Hospital Barros Luco Trudeau, Santiago, Chile
  • Javier Lundquist
    Departamento de Neuroradiología Intervencionista, Instituto Medico Eneri-Clinica La Sagrada Familia, Buenos Aires, Argentina
  • Esteban Scrivano
    Departamento de Neuroradiología Intervencionista, Instituto Medico Eneri-Clinica La Sagrada Familia, Buenos Aires, Argentina
  • Pedro Lylyk
    Departamento de Neuroradiología Intervencionista, Instituto Medico Eneri-Clinica La Sagrada Familia, Buenos Aires, Argentina

説明

<jats:sec><jats:title>Introduction</jats:title><jats:p> Twig-like middle cerebral artery configuration (Tw-MCA) is a rare and commonly misdiagnosed vascular anomaly characterized by a plexiform arterial network that replaces the normal M1 segment. The prevalence and clinical relevance of this anomaly is not fully established. </jats:p></jats:sec><jats:sec><jats:title>Material and methods</jats:title><jats:p> We sought to explore the prevalence of Tw-MCA in patients clinically referred to digital angiography in a single academic comprehensive endovascular center and evaluated the radiological and clinical findings among patients with hemorrhagic events. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> From 2011 to 2020, a total of 10,234 patients underwent a cerebral angiography at our institution. During this period, 9 (0.088%) Tw-MCAs were identified. Out of these, 5 patients (62.5%) were admitted due to an intracranial hemorrhage. Two patients had a ruptured intracranial aneurysm on the anterior communicating artery, one with multiple brain aneurysms; two patients presented an intraparenchymal hematoma (IPH) due to the presence of a periventricular anastomosis and one patient an intraventricular hemorrhage with unclear origin. </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> Tw-MCA is a very rare vascular anomaly associated with hemorrhagic events. Adequate identification of this anomaly is essential in order to avoid misdiagnosis as steno-occlusive disorders. </jats:p></jats:sec>

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