gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

Asymmetry of the anterior cerebral artery in patients with aneurysmal subarachnoid hemorrhage: The phantom menace!

Meeting Abstract

  • Mukesch Shah - Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
  • Matthias Reinhard - Klinikum Esslingen, Klinik für Neurologie und klinische Neurophysiologie, Esslingen, Deutschland
  • Roland Rölz - Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
  • Christian Scheiwe - Department of Neurosurgery, Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Deutschland
  • Ramazan Jabbarli - Universitätsklinikum Essen der Universität Duisburg-Essen, Klinik für Neurochirurgie, Essen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMi.01.08

doi: 10.3205/17dgnc360, urn:nbn:de:0183-17dgnc3606

Published: June 9, 2017

© 2017 Shah et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

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.