Intracranial anterior communicating artery

Intracranial aneurysms are not congenital but develop over the course of life. Approximately 10% of aneurysms are familial, and candidate genes identified thus far include those coding for the extracellular matrix. Saccular aneurysms tend to occur at branching points on the circle of Willis and proximal cerebral arteries approximately 40% on the anterior communicating artery complex, 30% on the posterior communicating artery or distal internal carotid artery, 20% on the middle cerebral artery and 10% in the posterior... 

Most arterial aneurysms arise at the bifurcation of major arteries, and this is also true for the intracranial location. Around 85% of all intracranial aneurysms originate from the anterior circulation. The most common location (30%-35%) is the anterior communicating artery (Acorn). However, many of these so-called Acorn aneurysms do have their origin at the A1/A2 junction of the anterior cerebral artery and do not involve the anterior communicating artery. Internal carotid and posterior communicating artery aneurysms account for 30% and middle cerebral artery (MCA) bifurcation aneurysms for 20%. Around 15% of intracranial aneurysms arise at the vertebrobasilar circulation. Half of them develop at the basilar tip (with various degrees of involvement of the PI segments) and the other 50% from other posterior fossa vessels. Aneurysms of the anterior inferior cerebellar artery (AICA) and vertebral artery (VA) aneurysms without involvement of the VA-PICA junction or the vertebrobasilar site are extremely rare. 

Fig. 10.1. Correct patient positioning for intracranial scans, light box indicates the scan volume, eye-lenses outside of scan volume. Note the titanium coils after endovascular coil embolization of an aneurysm at the anterior communication artery (ACoA)...

Haematologic Intravenous administration of recombinant tissue plasminogen activator (rtPA), also known as alteplase, is a common component of ischaemic stroke management, but its use is associated with intracranial haemorrhage in 6.4% of patients. A 51-year-old woman who had received IV rtPA for acute left middle cerebral artery thromboembolism later presented with subarachnoid haemorrhage from an acutely ruptured anterior communicating artery aneurysm. The patient xmderwent mechanical thromboembolectomy of the left middle cerebral artery occlusion with recanalization followed by coil embolization of the aneurysm, but she did not improve neurologjcally and ultimately died (32). ... 

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