Mechanical thrombolysis using coil in acute occlusion of fenestrate m1 segment.

A fenestrated middle cerebral artery (MCA) is a rare congenital anomaly, and is related to interference in the normal embryonic development of the MCA. Fenestrated MCA has been regarded to have no clinical significance other than a rare event of hemorrhage from associated aneurysm. However, the fenestration within the arterial trunk can be an obstacle against thrombus migration and may be associated with a major cerebral infarction. Moreover, the presence of this anomaly can be hardly detected prior to thrombolytic procedures, and emergent treatments are proceeded without any information of anatomical configurations. Therefore, the recanalization procedures would carry a high risk of intraprocedural complications. We report a rare case of MCA territory infarction from occlusion of fenestrated M1 segment, and also introduce a safe method of mechanical thrombolysis using coil.

Clinical and radiological features of patients with aplastic or twiglike middle cerebral arteries.

BACKGROUND: An aplastic or twiglike middle cerebral artery (Ap/T-MCA) is an extremely rare congenital anomaly related to interference in the normal embryonic development of the MCA. OBJECTIVE: To evaluate the clinical and radiological features of patients with an Ap/T-MCA. METHODS: A total of 1749 conventional cerebral angiography procedures were performed in 1282 patients from January 2005 to July 2011 at Daegu Fatima Hospital. The images were evaluated for cerebral arterial anomalies. The radiological features of an Ap/T-MCA, coexisting anomalies, and clinical manifestations were recorded. These prospectively maintained databases were analyzed retrospectively. RESULTS: Ap/T-MCAs were found in 15 patients (1.17% angiographic incidence). The anomalies were confined to unilateral M1 segment, and no stenoses were seen in the adjacent major arteries. Of 15 patients, 6 (40%) had hemorrhagic strokes, 5 (33.3%) had ischemic strokes, and 4 (26.7%) had no symptoms. Aneurysms were found in 5 patients (33.3%). Coexisting cerebral arterial anomalies were seen in 12 patients (80%). Ten patients underwent conservative treatments, and the remaining 5 underwent surgical treatments, such as hematoma aspiration, indirect revascularization, and clipping or coiling of aneurysms. CONCLUSION: An Ap/T-MCA is a rare anomaly and should be differentiated from moyamoya conditions and degenerative steno-occlusive diseases of the middle cerebral artery. Coexisting anomalies of the anterior or middle cerebral arteries are frequent. This anomaly is vulnerable to both hemorrhagic and ischemic strokes.