Show pageBacklinksCite current pageExport to PDFBack to top This page is read only. You can view the source, but not change it. Ask your administrator if you think this is wrong. ====== Twig-like middle cerebral artery ====== {{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1bUrbZONKdK06mHq3zM2pu9AfvGE1QCaUrZrxn31bnv2rESYHD/?limit=15&utm_campaign=pubmed-2&fc=20241221181626}} [[Aplastic middle cerebral artery]] or twig-like [[middle cerebral artery]] (Ap/T-MCA) is a congenital [[middle cerebral artery anomaly]] in which the MCA trunk is either stenotic or occluded with a collateral plexiform network. ===== Pathogenesis ===== Pathogenesis is unclear for a twig-like MCA and congenital and acquired factors can be involved ((Yu J. Current state and confusion of twig-like middle cerebral artery. Interv Neuroradiol. 2022 Aug 17:15910199221121380. doi: 10.1177/15910199221121380. Epub ahead of print. PMID: 35979607.)). A twig-like MCA disturbed cerebral hemodynamics. An associated aneurysm can occur in patients with twig-like MCAs ((Yu J. Current state and confusion of twig-like middle cerebral artery. Interv Neuroradiol. 2022 Aug 17:15910199221121380. doi: 10.1177/15910199221121380. Epub ahead of print. PMID: 35979607.)). ===== Clinical features ===== Twig-like MCAs can present subclinically and without clinical symptoms, hemorrhage, or ischemic strokes ((Yu J. Current state and confusion of twig-like middle cerebral artery. Interv Neuroradiol. 2022 Aug 17:15910199221121380. doi: 10.1177/15910199221121380. Epub ahead of print. PMID: 35979607.)). ---- ===== Neuroimaging ===== Digital subtracted angiography is the gold standard of all available imaging examinations ((Yu J. Current state and confusion of twig-like middle cerebral artery. Interv Neuroradiol. 2022 Aug 17:15910199221121380. doi: 10.1177/15910199221121380. Epub ahead of print. PMID: 35979607.)). Regular follow-up imaging (e.g., MRI, MRA, or CT angiography) may be recommended to monitor the condition of the MCA and any potential changes in vascular status, particularly if the patient is at risk for ischemia. Cerebrovascular Assessment: For patients with twig-like MCA anatomy, a more detailed assessment of cerebral blood flow, including Doppler studies or perfusion imaging, may be needed to understand how the brain is being supplied with blood. ---- [[Cinematic rendering]] allows for a more understandable and visually compelling way to study anatomical forms. It provides a better understanding of the structure, flow, and interaction within the body, making it useful for both professional and educational purposes ((Dong L, Lv M. Cinematic Rendering of [[Twig-Like Middle Cerebral Artery]]. Ann Neurol. 2024 Dec 21. doi: 10.1002/ana.27173. Epub ahead of print. PMID: 39707761.yze)). ===== Treatment ===== When treating a twig-like MCA, it is feasible to target the associated aneurysm, and extracranial-intracranial bypass can be effective in reducing the risk of strokes, but more evidence is needed. Now, the decision to perform surgery for twig-like MCAs should be made on a case-by-case basis ((Yu J. Current state and confusion of twig-like middle cerebral artery. Interv Neuroradiol. 2022 Aug 17:15910199221121380. doi: 10.1177/15910199221121380. Epub ahead of print. PMID: 35979607.)). ---- Treatment for a "twig-like" middle cerebral artery (MCA) typically depends on the clinical context in which the variant is discovered, especially if it is associated with ischemic events or other cerebrovascular issues. Here are some approaches: Management of Stroke or Ischemia: Acute Stroke Treatment: If a stroke is associated with a twig-like MCA variant, the treatment follows the same protocols as for other types of strokes, which may include thrombolysis (e.g., intravenous alteplase) or mechanical thrombectomy if there is evidence of an acute large vessel occlusion. Antithrombotic Therapy: For patients with small vessel disease or reduced blood flow in the MCA territory, antiplatelet therapy (e.g., aspirin, clopidogrel) or anticoagulation may be prescribed to reduce the risk of further ischemic events. Endovascular Procedures: In some cases, if there is significant stenosis or occlusion of the smaller branches of the MCA, procedures like stent placement or angioplasty might be considered, although these are less common for small or twig-like arteries due to their delicate nature. Risk Factor Management: Control of Hypertension: High blood pressure is a significant risk factor for cerebrovascular events. Controlling hypertension with medications such as ACE inhibitors, beta-blockers, or calcium channel blockers is critical. Diabetes and Lipid Control: Diabetes and hyperlipidemia can exacerbate ischemic risk. Managing blood glucose levels and lipid profiles (using statins, for instance) can help reduce vascular risk. Lifestyle Modifications: Encouraging lifestyle changes like smoking cessation, regular physical activity, and a heart-healthy diet can improve vascular health and reduce the likelihood of stroke or other complications. Follow-up and Monitoring: ==== Bypass Surgery ==== In rare cases where the twig-like MCA variant leads to chronic ischemia or persistent symptoms, cerebral revascularization surgery (such as superficial temporal artery-middle cerebral artery bypass) may be considered to provide an alternative route for blood flow to the brain. Superficial Temporal Artery-Middle Cerebral Artery (STA-MCA) Bypass: This is a common surgical intervention in cases of significant ischemia or stroke related to vascular abnormalities like a twig-like MCA. In this procedure, the superficial temporal artery (STA) is surgically connected to a branch of the MCA to provide an alternative blood flow route to the affected area of the brain. Indication: This surgery is typically reserved for patients with chronic ischemia or stroke who have poor collateral circulation due to a hypoplastic or twig-like MCA. ===== Case reports ===== A 37-year-old man who bypass surgery for T-MCA with intracerebral hemorrhage was successful, and the periventricular anastomosis, which could have caused the hemorrhage, was resolved early. The patient showed improvement after surgery, and the subsequent MRI, seven days after surgery, confirmed the disappearance of the periventricular anastomosis. Remarkably, no stroke recurrence was observed throughout the 15-month follow-up. This case suggests the usefulness of bypass surgery for T-MCA with hemorrhagic onset, especially when periventricular anastomosis is involved. Further research to determine the optimal timing and treatment approaches for such cases is required ((Tsukada A, Hirata K, Tsuda K, Fujita K, Yanaka K, Ishikawa E. Early Resolution of Abnormal Vascular Networks After Superficial Temporal Artery to Middle Cerebral Artery (STA-MCA) Bypass Surgery for Twig-Like Middle Cerebral Artery With Intracerebral Hemorrhage: A Case Report. Cureus. 2024 Oct 30;16(10):e72740. doi: 10.7759/cureus.72740. PMID: 39618682; PMCID: PMC11607139.)). twig-like_middle_cerebral_artery.txt Last modified: 2024/12/21 23:32by 127.0.0.1