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Purpose <p>The twig-like middle cerebral artery (TL-MCA) is a&#xa0;vascular anomaly reconstituting the MCA-M1 segment through a&#xa0;plexiform arterial network. Most patients with TL-MCA have a&#xa0;high risk of hemorrhage, but the associated vascular anatomical risk factors are poorly understood. To investigate the angioarchitecture of TL-MCA in detail to distinguish the radiological differences between hemorrhagic and non-hemorrhagic onset.</p> Methods <p>3214 cerebral digital subtraction angiography procedures were performed, and patients with TL-MCA were included and their clinical and anatomical characteristics were retrospectively reviewed.</p> Results <p>12&#xa0;patients (median age&#xa0;47&#xa0;years, and 9&#xa0;women) with TL-MCA were included (incidence rate, 0.37%). Among them, four had hemorrhagic stroke, five had ischemic stroke, and three had no symptoms. Perforator anastomoses were identified in five patients (41.6%). Among the four patients with intraparenchymal hemorrhage (IPH), three had looping lenticulostriate artery (LSA) anastomoses and one had non-looping LSA anastomosis. One looping LSA anastomosis was discovered fortuitously in a&#xa0;patient explored for headaches. The recurrent artery of Heubner, which is responsible for the plexiform arterial network, was identified in 10&#xa0;patients (83.3%). Angiographic evolutions (de novo TL-MCA) were observed in three patients, and one patient experienced a&#xa0;clinical evolution of a&#xa0;TL-MCA with non-looping LSA anastomosis, progressing from no symptoms to IPH.</p> Conclusions <p>In this small series, looping LSA anastomoses were mainly observed in TL-MCA with IPH. This anatomical disposition could represent a&#xa0;potential risk factor. The TL-MCA always affects the subpallial segment of the MCA-M1, and may be a&#xa0;subpallium-related pathology.</p>

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Angioarchitecture of Twig-like Middle Cerebral Artery: the Looping Lenticulostriate Artery Anastomoses as an Angiographic Landmark for Hemorrhagic Presentation

  • 期刊论文

  • 发表日期：

    2025年2月5日

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  • Bikei Ryu,
  • Alessandro Sgreccia,
  • Silvia Pizzuto,
  • Federico Di Maria,
  • Yasunari Niimi,
  • Georges Rodesch,
  • Arturo Consoli

摘要

Purpose

The twig-like middle cerebral artery (TL-MCA) is a vascular anomaly reconstituting the MCA-M1 segment through a plexiform arterial network. Most patients with TL-MCA have a high risk of hemorrhage, but the associated vascular anatomical risk factors are poorly understood. To investigate the angioarchitecture of TL-MCA in detail to distinguish the radiological differences between hemorrhagic and non-hemorrhagic onset.

Methods

3214 cerebral digital subtraction angiography procedures were performed, and patients with TL-MCA were included and their clinical and anatomical characteristics were retrospectively reviewed.

Results

12 patients (median age 47 years, and 9 women) with TL-MCA were included (incidence rate, 0.37%). Among them, four had hemorrhagic stroke, five had ischemic stroke, and three had no symptoms. Perforator anastomoses were identified in five patients (41.6%). Among the four patients with intraparenchymal hemorrhage (IPH), three had looping lenticulostriate artery (LSA) anastomoses and one had non-looping LSA anastomosis. One looping LSA anastomosis was discovered fortuitously in a patient explored for headaches. The recurrent artery of Heubner, which is responsible for the plexiform arterial network, was identified in 10 patients (83.3%). Angiographic evolutions (de novo TL-MCA) were observed in three patients, and one patient experienced a clinical evolution of a TL-MCA with non-looping LSA anastomosis, progressing from no symptoms to IPH.

Conclusions

In this small series, looping LSA anastomoses were mainly observed in TL-MCA with IPH. This anatomical disposition could represent a potential risk factor. The TL-MCA always affects the subpallial segment of the MCA-M1, and may be a subpallium-related pathology.