Artikel
Asymmetry of the anterior cerebral artery in patients with aneurysmal subarachnoid hemorrhage: The phantom menace!
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Veröffentlicht: | 9. Juni 2017 |
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Gliederung
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Objective: An asymmetry of A1-segments (A1SA) of anterior cerebral arteries (ACA) is an assumed risk factor for development of anterior communicating artery aneurysms (ACOAA). It is unknown whether A1SA is also of clinical relevance after aneurysm rupture. This study investigates the impact of A1SA on the clinical course and outcome in patients with aneurysmal subarachnoid hemorrhage (SAH).
Methods: 594 consecutive SAH patients treated at our institution between January 2005 and December 2012 were analyzed. The occurrence and severity of cerebral infarctions in the ACA territories were evaluated upon the follow-up computed tomography scans up to 6 weeks after SAH. Moreover, the risk for unfavorable outcome (defined as >3 points on the modified Rankin scale) at 6 months after SAH was assessed.
Results: A1SA was identified in digital subtraction angiographies of 127 patients (21.4%) and was strongly associated with ACOAA (p<0.0001, odds ratio (OR)=13.7). A1SA independently correlated with occurrence of ACA-infarction in patients with ACOAA (p=0.047) and the remaining SAH cohort (p=0.015). Among patients undergoing ACOAA coiling, A1SA was independently associated with the severity of ACA infarction (p=0.023) and unfavorable functional outcome (p=0.045, OR=2.4).
Conclusion: A1SA is a common anatomic variation for SAH patients and is strongly associated with ACOAA. Moreover, the presence of A1SA independently increases the likelihood of ACA-infarction. In SAH patients undergoing ACOAA coiling, A1SA carries the risk for severe ACA-infarction and, therefore, unfavorable outcome.