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Published online: 2024-11-20

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A bilateral fetal origin of the posterior cerebral artery coexisting with an absent A1 segment of the anterior cerebral artery

George Triantafyllou1, Savvas Melissanidis2, Łukasz Olewnik3, Panagiotis Papanagiotou4, George Tsakotos1, Nicol Zielinska3, Katerina Vassiou5, Maria Piagkou1

Abstract

Background: The cerebral arterial circle variants are well-described due to their clinical significance for neurosurgeons and neuroradiologists.

Materials and methods: This magnetic resonance angiography (MRA) report describes the unusual coexistence of three cerebral variants incidentally identified in a 44-year-old female patient.

Results: The right-sided first segment (A1) of the anterior cerebral artery (ACA) was absent, and both the posterior cerebral arteries (PCAs) originated from the internal carotid arteries (ICAs). Thus, the unilateral A1 segment absence coexisted with a bilateral PCA of fetal origin. These variants’ coexistence significantly disrupts the patient’s primary collateral pathway.

Conclusions: The clinical significance and consequences of such variants after stroke or transient ischemic attack cannot be overstated, underscoring the importance of the current imaging findings in understanding and managing these conditions.

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References

  1. Caruso G, Vincentelli F, Rabehanta P, et al. Anomalies of the P1 segment of the posterior cerebral artery: early bifurcation or duplication, fenestration, common trunk with the superior cerebellar artery. Acta Neurochir (Wien). 1991; 109(1-2): 66–71.
  2. Davidoiu AM, Mincă DI, Rusu MC, et al. The fetal type of posterior cerebral artery. Medicina (Kaunas). 2023; 59(2).
  3. Dharmasaroja PA, Uransilp N, Piyabhan P. Fetal origin of posterior cerebral artery related to poor collaterals in patients with acute ischemic stroke. J Clin Neurosci. 2019; 68: 158–161.
  4. Guarnizo A, Marin Muñoz J. Anterior cerebral artery trifurcation with infraoptic origin and contralateral A1 segment absence. Surg Radiol Anat. 2022; 44(2): 299–301.
  5. Kruszka P, Buscetta A, Acosta MT, et al. Circle of Willis anomalies in Turner syndrome: absent A1 segment of the anterior cerebral artery. Birth Defects Res. 2019; 111(19): 1584–1588.
  6. Lippert H, Pabst R. Arterial variations in man: classification and frequency. Bergmann Verlag, Munich 1985.
  7. Padget DH. The development of the cranial arteries in the human embryo. Contrib Embryol. 1948; 32: 205–261.
  8. Şahin H, Pekçevik Y. Anatomical variations of the circle of Willis: evaluation with CT angiography. Anatomy. 2018; 12(1): 20–26.
  9. Trandafilović M, Vasović L, Vlajković S, et al. Bilateral aplasia of the anterior cerebral artery in the presence of its vascular source: a case report. Surg Radiol Anat. 2022; 44(9): 1277–1280.
  10. Uchino A, Irie T. Accessory posterior cerebral artery (hyperplastic anterior choroidal artery) associated with contralateral accessory middle cerebral artery incidentally diagnosed by magnetic resonance angiography. Surg Radiol Anat. 2024; 46(3): 313–316.
  11. Uchino A, Nomiyama K, Takase Y, et al. Anterior cerebral artery variations detected by MR angiography. Neuroradiology. 2006; 48(9): 647–652.
  12. Uchino A, Saito N, Takahashi M, et al. Variations of the posterior cerebral artery diagnosed by MR angiography at 3 tesla. Neuroradiology. 2016; 58(2): 141–146.
  13. Uchino A, Tokushige K. Posterior cerebral artery (PCA)-accessory PCA (hyperplastic anterior choroidal artery) anastomosis detected on magnetic resonance angiography. Surg Radiol Anat. 2024; 46(5): 679–683.