title: Clinical relevance of anterior cerebral artery asymmetry in aneurysmal subarachnoid hemorrhage.
abstract: OBJECTIVE An asymmetry of the A1segments (A1SA) of the anterior cerebral arteries (ACAs) is an assumed risk factor for the development of anterior communicating artery aneurysms (ACoAAs). It is unknown whether A1SA is also clinically relevant after aneurysm rupture. The authors of this study investigated the impact of A1SA on the clinical course and outcome of patients with aneurysmal subarachnoid hemorrhage (SAH). METHODS The authors retrospectively analyzed data on consecutive SAH patients treated at their institution between January 2005 and December 2012. The occurrence and severity of cerebral infarctions in the ACA territories were evaluated on follow-up CT scans up to 6 weeks after SAH. Moreover, the risk for an unfavorable outcome (defined as > 3 points on the modified Rankin Scale) at 6 months after SAH was assessed. RESULTS A total of 594 patients were included in the final analysis. An A1SA was identified on digital subtraction angiography studies from 127 patients (21.4%) and was strongly associated with ACoAA (p < 0.0001, OR 13.7). An A1SA independently correlated with the occurrence of ACA infarction in patients with ACoAA (p = 0.047) and in those without an ACoAA (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). CONCLUSIONS An A1SA is a common anatomical variation in 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 thus an unfavorable outcome. Clinical trial registration no.: DRKS00005486 ( http://www.drks.de/ ).
authors.affiliation: Departments of 1 Neurosurgery.|Department of Neurosurgery, University Hospital Essen; and.
authors.forename: Ramazan
authors.initials: R
authors.lastname: Jabbarli
authors.affiliation: Neurology and Neurophysiology, and.|Department of Neurology and Clinical Neurophysiology, Klinikum Esslingen, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Reinhard
authors.affiliation: Departments of 1 Neurosurgery.
authors.forename: Roland
authors.initials: R
authors.lastname: Roelz
authors.affiliation: Institute for Medical Biometry and Medical Informatics, University Medical Center Freiburg.
authors.forename: Klaus
authors.initials: K
authors.lastname: Kaier
authors.affiliation: Departments of 1 Neurosurgery.
authors.forename: Astrid
authors.initials: A
authors.lastname: Weyerbrock
authors.affiliation: Neuroradiology.
authors.forename: Christian
authors.initials: C
authors.lastname: Taschner
authors.affiliation: Departments of 1 Neurosurgery.
authors.forename: Christian
authors.initials: C
authors.lastname: Scheiwe
authors.affiliation: Departments of 1 Neurosurgery.
authors.forename: Mukesch
authors.initials: M
authors.lastname: Shah
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D020771:Anterior Cerebral Artery / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging*; D055815:Young Adult
keywords: A1 asymmetry; A1SA = asymmetry of the A1 segments; ACA = anterior cerebral artery; ACoA = anterior communicating artery; ACoAA = ACoA aneurysm; DSA = digital subtraction angiography; EVD = external ventricular drainage; HH = Hunt and Hess; SAH = subarachnoid hemorrhage; TCD = transcranial Doppler; aOR = adjusted odds ratio; anterior communicating artery; aplasia; cerebral infarct; functional outcome; hypoplasia; mRS = modified Rankin Scale; subarachnoid hemorrhage; vascular disorders