The Anatomical Variation of the Distal Anterior Cerebral Artery: An Angiographic Study in a Greek Population Sample

Abstract

Objective The current retrospective angiographic study establishes the rates of variants in the distal anterior cerebral artery (DACA) in a sample of the Greek population. Methods Data were collected from 456 patients who underwent two-dimensional (2D) or three-dimensional (3D) digital subtraction angiography (DSA) of the carotid and vertebral arteries bilaterally. The study focused on patients with good visualization of the anterior and posterior circulations and employed magnetic resonance (MR) or computed tomography (CT) angiography for 3D reconstruction. The anterior cerebral artery (ACA) was classified into one of its two basic configurations, that is, with or without the callosomarginal artery (CMA). The bihemispheric, median, and azygos ACA patterns were also identified. Results The majority (373/456, 81.8%) exhibited a typical DACA pattern. The bihemispheric, median, and azygos patterns were identified in 66/456 (14.5%), 10/456 (2.2%), and 7/456 (1.5%), respectively. The CMA was present in 824/912 (90.4%) of the hemispheres, with a trend toward male predominance for bilateral presence (males: 167/192, 86.98%; females: 210/264, 79.55%; p = 0.05). In particular, the CMA was present significantly more frequently (p = 0.002) in the left hemispheres of male patients. Gender differences in CMA presence persisted in the analysis of the patients with a typical DACA pattern. Conclusion This study provides insights into the variations of the DACA in the Greek population. The observed gender differences in CMA rates suggest potential morphological variations in cerebral vasculature between males and females and contribute to a better understanding of vascular anatomy for clinical and surgical applications.

Keywords: anatomical variations; angiography; anterior cerebral artery (aca); callosomarginal artery; cerebral vessels.

Figure 1. Median and Azygos ACA

Angiography images illustrating the (a) median and (b) azygos ACA patterns ACA: anterior cerebral artery

Figure 2. Bihemispheric ACA

A collage of two angiography images from the same patient, illustrating the presence of the bihemispheric ACA pattern. Vessels in red, essentially the middle cerebral artery and its branches, are those highlighted after the injection of contrast agent into the right internal carotid artery. Vessels in grey are those highlighted after the injection of contrast agent into the left internal carotid artery. Note the vascularization of frontal regions bilaterally from vessels originating from the left internal carotid artery ACA: anterior cerebral artery

Figure 3. Callosomarginal Artery

Angiography images of two patients: (a) one without a CMA and (b) one with a CMA CMA, callosomarginal artery; PrcA, pericallosal artery