Aims and objectives
Abbreviations used:
MCA: middle cerebral artery
ED: emergency department
A correct diagnosis of cerebral ischemic stroke,
can not be separated from a careful anatomical evaluation of the cerebral arterial branches involved.
Although human anatomy seems an "acquired" result of modern medicine,
it still leaves some doubts about the correlation between levels of average cerebral artery occlusion (in particular the distal branches at M1) and the areas of cerebral parenchymal ischemia involved.
MCA is divided into a proximal (M1) and a distal (M2 and beyond).
M1...
Methods and materials
- Literature was reviewed,
including both anatomical/microsurgical studies and works focused on endovascular procedures; search expressions “M2 OR distal AND cerebral AND artery OR segment”
- Starting from a single-centre experience as “Hub” Stroke Center Hospital,
mCTA and pCT of more than five hundred consecutive Patients admitted for ischemic stroke were reviewed.
All examinations were performed at Emergency Department immediately after neurological complete evaluation,
employing a 64-slices multidetector CT scanner.
Every patient underwent non-contrast CT of the head,
mCTA (using 50 mL of iodine contrast...
Results
Review of nomenclature
Review of literature brought differences in denomination of some MCA portions distal to the trunk of M1 segment.
In particular,
the following portion showed controversial nomenclature:
- M1 segment: inner portions may be distinguished as proximal and distal trunk,
pre-bifurcation and post-bifurcation segment; pre-insular/insular M1 divisions.
- M2 segments: trunk; M2 divisions and branches; M2 insular (ascending and descending) portions.
In our research,
more agreement was found in consulted literature for defining of arterial vessels going through cerebral opercula as opercular branches,...
Conclusion
· Given some limitations (retrospective design,
lack of correlation with clinical outcome and nervous tissues state assessed with perfusional imaging),
the result of this single-center study confirmed the role of multimodal CT in the ischemic stroke triage,
by indentifying M2-M3 occlusion and vascular territories,
in respect of collateral pial circulation,
thus suggesting an emerging role in future diagnostic studies and as a tool to be implemented in controlled clinical studies.
· The depicted review of literature,
although not conducted with systematic methods,
focused on definitions...
References
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Considerations in the surgical treatment of superior-wall type aneurysm at the proximal (M1) segment of the middle cerebral artery.Acta Neurochir (Wien).
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Review.
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