title: A1 segment hypoplasia associated with cerebral infarction after anterior communicating artery aneurysm rupture.
abstract: BACKGROUND
  Congenital hypoplasia or absence of the A1 segment of the anterior cerebral artery (ACA) has been associated with increased incidence of berry aneurysms at the anterior communicating artery (Acom) complex. It is not known, however, whether this anatomic variant also predisposes patients to complications after aneurysmal subarachnoid hemorrhage.
  
  
  METHODS
  Patients were included for analysis if they presented to our institution for clipping or coiling of an Acom aneurysm between the years of 2001 and 2013. Patients were deemed to have cerebral infarction if a new hypodensity in a vascular distribution was visualized on CT imaging. The association between A1 segmental abnormalities and radiologic infarction was subsequently evaluated in a risk-adjusted manner using stepwise multivariable logistic regression analysis.
  
  
  RESULTS
  Of 145 patients who presented with aneurysmal subarachnoid hemorrhage after rupture of an Acom aneurysm, 31 (21.4%) had a hypoplastic or absent A1 segment. On univariate analysis, there was a trend toward an increased rate of radiologic infarction in patients with A1 segment abnormalities (OR=2.11, 95% CI: 0.93-4.79; P=0.0757). On multivariable analysis, a hypoplastic or absent A1 segment was significantly associated with an increased rate of radiologic infarction (OR=2.54, 95% CI: 1.02-6.43; P=0.0466).
  
  
  CONCLUSIONS
  Our results suggest that a hypoplastic or absent A1 segment is associated with cerebral infarction following subarachnoid hemorrhage from ruptured Acom aneurysms, indicating a potential need for heightened vigilance and a reduced threshold for therapeutic intervention in patients harboring this abnormality.
authors.affiliation: Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Rinaldo
authors.affiliation: Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Brandon A
authors.initials: BA
authors.lastname: McCutcheon
authors.affiliation: Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Kendall A
authors.initials: KA
authors.lastname: Snyder
authors.affiliation: Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Porter
authors.affiliation: Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Bydon
authors.affiliation: Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA.|Interventional Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lanzino
authors.affiliation: Section of Neurocritical Care, Department of Neurology, Mayo Clinic, Rochester, MN, USA - rabinstein.alejandro@mayo.edu.
authors.forename: Alejandro A
authors.initials: AA
authors.lastname: Rabinstein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000150:complications* / Q000601:surgery; D020771:Anterior Cerebral Artery / Q000601:surgery; D002533:Cerebral Angiography / Q000379:methods; D002544:Cerebral Infarction / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000209:etiology*