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      A Ruptured Aneurysm at the Infraoptic Azygous Anterior Cerebral Artery with the Contralateral Internal Carotid Artery Agenesis Treated by Y-stent Assisted Coil Embolization

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          Abstract

          Infraoptic anterior cerebral artery (ACA) is an extremely rare congenital anomaly. This anomalous artery usually arises from the intradural internal carotid artery (ICA) near the level of the ophthalmic artery (OA) or rarely from the extradural ICA. This anomaly frequently harbors a cerebral aneurysm, and may involve other coexisting vascular anomalies. In the case of this anomaly, surgical treatment of the aneurysm at the proximal ACA or anterior communicating artery (ACoA) may sometimes be difficult, because the veiled proximal ACA by the optic nerve would make proximal control inconvenient and the vertical midline segment of the proximal ACA would frequently form a superiorly directing aneurysm with a relatively high position. We report on an extremely rare case of a ruptured aneurysm at the infraoptic azygous ACA, possibly having an extradural origin, accompanied by contralateral ICA agenesis, and also introduce a feasible method for treatment by Y-stent assisted coil embolization.

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          Infraoptic anterior cerebral artery: review, report of two cases and an anatomical classification.

          Infraoptic course of the pre-communicating anterior cerebral artery (A1) is a rare anomaly. In total, there are 42 examples reported in the literature. We report two further patients. The first had an intradural cerebral aneurysm at the low bifurcation of an internal carotid artery (ICA) with bilateral infraoptic course of A1. The second had right infraoptic course of A1 with associated left parietal cerebral arteriovenous malformation and is the first report of such an association. Overall, 59% of the examples were associated with cerebral aneurysms. Different terminology such as carotid-anterior cerebral artery anastomosis and infraoptic anterior cerebral artery has been used. Having analyzed the reports of infraoptic A1, we found the vascular configurations of the A1 could be better described by classifying them into four types. Such a classification can facilitate analysis of the embryogenesis explanation for this anomaly and the pathogenesis of the associated aneurysms. Besides, such a classification also has some practical implications.
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            Diagnostic cerebral angiography

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              An unusual human anterior cerebral artery.

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                Author and article information

                Journal
                J Cerebrovasc Endovasc Neurosurg
                J Cerebrovasc Endovasc Neurosurg
                JCEN
                Journal of Cerebrovascular and Endovascular Neurosurgery
                Korean Society of Cerebrovascular Surgeons; Korean Society of Endovascular Surgery
                2234-8565
                2287-3139
                September 2012
                28 September 2012
                : 14
                : 3
                : 237-242
                Affiliations
                Department of Neurosurgery, Daegu Fatima Hospital, Daegu, Korea.
                Author notes
                Correspondence to Yoon-Soo Lee, MD. Department of Neurosurgery, Daegu Fatima Hospital, 576-31 Sinam-dong, Dong-gu, Daegu 701-600, Korea. Tel: (001) 82-53-940-7330, 7339, Fax: (001) 82-53-954-7417, paulyoonsoolee@ 123456hanmail.net
                Article
                10.7461/jcen.2012.14.3.237
                3491221
                23210054
                ef1d0ffc-7df2-40ca-a247-bddab354d577
                © 2012 Journal of Cerebrovascular and Endovascular Neurosurgery

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 26 July 2012
                : 16 August 2012
                : 20 August 2012
                Categories
                Case Report

                Surgery
                infraoptic,anterior cerebral artery,y-stent
                Surgery
                infraoptic, anterior cerebral artery, y-stent

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