title: Larger A1/M1 diameter ratio predicts embolic anterior cerebral artery territorial stroke.
abstract: OBJECTIVE
  In contrast to middle cerebral artery territory strokes, anterior cerebral artery strokes (ACAS) occur rarely. The low frequency of ACAS, in relation to middle cerebral artery territory strokes, may be explained by differences in ACA and middle cerebral artery anatomy influencing their respective flow-directed embolism rates. We aimed to determine whether variability in ACA anatomy, and in particular A1 segment diameter, is associated with embolic ACAS.
  
  
  METHODS
  Consecutive patients admitted to Boston Medical Center with embolic ACAS were reviewed. Ipsilateral and contralateral A1 diameters, M1 diameters, and terminal internal carotid artery bifurcation angles were measured from computed tomographic angiography and MRI angiography images. We compared these measurements between cases of ACAS and consecutive cases of embolic middle cerebral artery territory strokes.
  
  
  RESULTS
  The study comprised 55 individuals (27 ACAS, 28 middle cerebral artery territory strokes) with mean age of 69 years. In multivariate regression analysis, larger ipsilateral A1 diameters (odds ratio per 1 mm increment: 8.5; 95% confidence interval, 1.4-53.3) and ipsilateral A1/M1 diameter ratio (odds ratio per 10% increment: 1.8; 95% confidence interval, 1.2-2.9) were associated with ACAS, whereas larger ipsilateral M1 diameters was protective for ACAS (odds ratio per 1 mm increment: 0.8; 95% confidence interval, 0.0-0.9).
  
  
  CONCLUSIONS
  Larger ipsilateral A1 diameters and A1/M1 diameter ratio are associated with embolic ACAS. These findings suggest that A1 diameters and M1 diameters are important in determining the path of emboli that reach the terminal internal carotid artery.
authors.affiliation: From the Massachusetts General Hospital, Harvard Medical School, Boston (A.S.); Boston Medical Center, Boston University School of Medicine, MA (H.M., K.F., K.D., H.L., J.R.R., A.P., T.N.N., C.S.K., V.L.B.); and Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada (P.T.). ashkan.sho@gmail.com.
authors.forename: Ashkan
authors.initials: A
authors.lastname: Shoamanesh
authors.affiliation: From the Massachusetts General Hospital, Harvard Medical School, Boston (A.S.); Boston Medical Center, Boston University School of Medicine, MA (H.M., K.F., K.D., H.L., J.R.R., A.P., T.N.N., C.S.K., V.L.B.); and Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada (P.T.).
authors.forename: Hesham
authors.initials: H
authors.lastname: Masoud
authors.affiliation: From the Massachusetts General Hospital, Harvard Medical School, Boston (A.S.); Boston Medical Center, Boston University School of Medicine, MA (H.M., K.F., K.D., H.L., J.R.R., A.P., T.N.N., C.S.K., V.L.B.); and Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada (P.T.).
authors.forename: Katrina
authors.initials: K
authors.lastname: Furey
authors.affiliation: From the Massachusetts General Hospital, Harvard Medical School, Boston (A.S.); Boston Medical Center, Boston University School of Medicine, MA (H.M., K.F., K.D., H.L., J.R.R., A.P., T.N.N., C.S.K., V.L.B.); and Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada (P.T.).
authors.forename: Kaylyn
authors.initials: K
authors.lastname: Duerfeldt
authors.affiliation: From the Massachusetts General Hospital, Harvard Medical School, Boston (A.S.); Boston Medical Center, Boston University School of Medicine, MA (H.M., K.F., K.D., H.L., J.R.R., A.P., T.N.N., C.S.K., V.L.B.); and Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada (P.T.).
authors.forename: Helena
authors.initials: H
authors.lastname: Lau
authors.affiliation: From the Massachusetts General Hospital, Harvard Medical School, Boston (A.S.); Boston Medical Center, Boston University School of Medicine, MA (H.M., K.F., K.D., H.L., J.R.R., A.P., T.N.N., C.S.K., V.L.B.); and Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada (P.T.).
authors.forename: Jose R
authors.initials: JR
authors.lastname: Romero
authors.affiliation: From the Massachusetts General Hospital, Harvard Medical School, Boston (A.S.); Boston Medical Center, Boston University School of Medicine, MA (H.M., K.F., K.D., H.L., J.R.R., A.P., T.N.N., C.S.K., V.L.B.); and Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada (P.T.).
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Pikula
authors.affiliation: From the Massachusetts General Hospital, Harvard Medical School, Boston (A.S.); Boston Medical Center, Boston University School of Medicine, MA (H.M., K.F., K.D., H.L., J.R.R., A.P., T.N.N., C.S.K., V.L.B.); and Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada (P.T.).
authors.forename: Philip
authors.initials: P
authors.lastname: Teal
authors.affiliation: From the Massachusetts General Hospital, Harvard Medical School, Boston (A.S.); Boston Medical Center, Boston University School of Medicine, MA (H.M., K.F., K.D., H.L., J.R.R., A.P., T.N.N., C.S.K., V.L.B.); and Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada (P.T.).
authors.forename: Thanh N
authors.initials: TN
authors.lastname: Nguyen
authors.affiliation: From the Massachusetts General Hospital, Harvard Medical School, Boston (A.S.); Boston Medical Center, Boston University School of Medicine, MA (H.M., K.F., K.D., H.L., J.R.R., A.P., T.N.N., C.S.K., V.L.B.); and Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada (P.T.).
authors.forename: Carlos S
authors.initials: CS
authors.lastname: Kase
authors.affiliation: From the Massachusetts General Hospital, Harvard Medical School, Boston (A.S.); Boston Medical Center, Boston University School of Medicine, MA (H.M., K.F., K.D., H.L., J.R.R., A.P., T.N.N., C.S.K., V.L.B.); and Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada (P.T.).
authors.forename: Viken L
authors.initials: VL
authors.lastname: Babikian
mesh_terms: D000368:Aged; D020771:Anterior Cerebral Artery / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000503:physiopathology; D002343:Carotid Artery, Internal / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000503:physiopathology; D002533:Cerebral Angiography; D003430:Cross-Sectional Studies; D005260:Female; D006439:Hemodynamics; D006801:Humans; D020243:Infarction, Anterior Cerebral Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D013923:Thromboembolism
keywords: cerebral infarction; cerebrovascular circulation; embolism; hemodynamics