Anterior cerebral artery

Anterior cerebral artery syndrome refers to symptoms that follow a stroke occurring in the area normally supplied by one of the arteries. It is characterized by weakness and sensory loss in the lower leg and foot opposite to the lesion and behavioral changes.

Structure

The anterior cerebral artery is divided into 5 segments. Its smaller branches: the callosal (supracallosal) arteries are considered to be the A4 and A5 segments.

• A1 originates from the internal carotid artery and extends to the anterior communicating artery (AComm). The anteromedial central (medial lenticulostriate) arteries arise from this segment as well as the AComm, which irrigates the caudate nucleus and the anterior limb of the internal capsule
• A2 extends from the AComm to the bifurcation forming the pericallosal and callosomarginal arteries. The recurrent artery of Heubner (distal medial striate artery), which irrigates the internal capsule, usually arises at the beginning of this segment near the AComm. Two branches arise from this segment:
  • Orbitofrontal artery (medial frontal basal): Arises a small distance away from the AComm
  • Frontopolar artery (polar frontal): Arises after the orbitofrontal, close to the curvature of A2 over the corpus callosum. It can also originate from the callosal marginal.
• A3, also termed the pericallosal artery, is one of the (or the only) main terminal branches of the ACA, which extends posteriorly in the pericallosal sulcus to form the internal parietal arteries (superior, inferior) and the precuneal artery. This artery may form an anastomosis with the posterior cerebral artery.
  • Callosal marginal artery: A commonly present terminal branch of the ACA, which bifurcates from the pericallosal artery. This artery in turn branches into the medial frontal arteries (anterior, intermediate, posterior), and the paracentral artery, with the cingulate branches arising throughout its length. Depending on anatomical variation, the callosal marginal artery may be none discrete or not be visible. In the latter case, the branches mentioned will originate from the pericallosal artery. In a study of 76 hemispheres, the artery was present in only 60% of the cases. Angiography studies cite that the vessel can be seen 67% or 50% of the time.

Development

The anterior cerebral artery develops from a primitive anterior division of the internal carotid artery that initially supplies the optic and olfactory regions. This anterior division, which appears at the twenty-eighth day of development, also forms the middle cerebral artery and the anterior choroidal artery. The anterior cerebral arteries grow toward each other and form the anterior communicating artery at the 21–24 mm stage of the embryo.

Variation

The anterior cerebral artery shows considerable variation. In a study made using MRA, the most common variation was an underdeveloped A1 segment (5.6%), followed by the presence of an extra A2 segment (3%). In 2% of cases there was only one A2 segment.