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. 2020 Jan;8(2-6):231-241.
doi: 10.1159/000502545. Epub 2019 Sep 25.

The Angiographic Anatomy of the Sphenoidal Segment of the Middle Cerebral Artery and Its Relevance in Mechanical Thrombectomy

Rakesh Khatri  1 , Mohtashim Arbaab Qureshi  1 , Mohammad Rauf A Chaudhry  1 , Alberto Maud  1 , Anantha Ramana Vellipuram  1 , Salvador Cruz-Flores  1 , Gustavo Jose Rodriguez  1
Affiliations

The Angiographic Anatomy of the Sphenoidal Segment of the Middle Cerebral Artery and Its Relevance in Mechanical Thrombectomy

Rakesh Khatri et al. Interv Neurol. 2020 Jan.

Abstract

Objective: The middle cerebral artery (MCA) is the most commonly treated artery in mechanical thrombectomy stroke trials; however, there is no pragmatic agreement about the segmental anatomy and nomenclature utilized. It results in significant clinical-radiological dissociation and introduces bias in research trials. The purpose of the study is to review and compare angiographic anatomy with microsurgical anatomy literature of the MCA with emphasis on the discrepancy.

Methodology: Consecutive cerebral angiograms between January 2011 and March 2014 were retrospectively reviewed by endovascular surgical neuroradiologists. Information about the anatomy of the sphenoidal segment of the MCA classified as classic and non-classic pattern, the lenticulostriate artery takeoff pattern, and the course angulation of the sphenoidal segment were studied.

Results: A total of 500 patients, 886 cerebral angiograms, were reviewed. We found the classic pattern of the main trunk MCA bifurcation and a straight angulation course in less than half of the cases. The lenticulostriate arteries arose not only from the main trunk but also from its divisions in more than half of the cases.

Conclusion: It is important to corroborate our findings and to develop a pragmatic classification to accurately assess MCA occlusions from the radiological and clinical perspective.

Keywords: M1 segment; Main trunk; Middle cerebral artery; Middle cerebral artery classification; Sphenoidal segment.

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Conflict of interest statement

None of the authors have any conflicts of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
a, b Angiographic Sylvian point. The ASP normally lies 30–43 mm from the inner table of the skull on a routine AP view and is located at the halfway point on the clinoparietal line (points a, b).
Fig. 2
Fig. 2
a Classic bifurcation. b Non-classic bifurcation. c Early bifurcation.
Fig. 3
Fig. 3
a–e Angular variation of the sphenoidal segment. a Oblique descent. b Convexity downwards. c Straight. d Oblique course dorsad. e Convexity dorsad.
See this image and copyright information in PMC

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