Twig-like Middle Cerebral Artery: Considerations of Twig Structure and Stroke Onset in Asymptomatic Cases

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  • Twig-like middle cerebral artery ─異常血管網の構造と無症候例の脳卒中発症に関する考察─

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<p>The twig-like middle cerebral artery (T-MCA) is a rare disease, and its nature remains unclear. Herein, we report eight cases of T-MCA. We analyzed the structure of the twigs (plexiform arterial networks) and the risk of stroke in asymptomatic patients with the review of related literature.</p><p>Eight patients (four men and four women aged 20–68 years, mean age: 50.1 years) with T-MCA (five right sides and three left sides) were reported in our department between 2008 and 2020. Seven patients were asymptomatic and one had a transient ischemic attack (TIA) on presentation.</p><p>Based on radiological findings, the twigs were supplied mainly by two different types of arterial channels. One artery originated from the anterior cerebral artery (A1/A2), and the other from the internal carotid artery, including the anterior choroidal artery. These two types of arterial channels are similar to the already-known anomalous arteries, accessory MCA and duplicated MCA.</p><p>Through a literature search, 28 cases of asymptomatic T-MCA were identified, including our seven cases; 26 of these 28 cases were subjected to conservative treatment. Of the 26 patients, 8 (30.8%) had a stroke during follow-up (TIA: 1, infarction: 1, intracerebral hemorrhage: 2, and subarachnoid hemorrhage: 4). All strokes, regardless of type, occurred exclusively on the side of the hemisphere with the T-MCA. Asymptomatic patients with T-MCA should be carefully monitored while paying attention to the risk of stroke.</p>

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