The Falcate Artery: Its Dynamics in Vasospasm

Abhishek Kotwal; Ansan Joseph; Karthik Kulanthaivelu; Richa Singh Chauhan; Chandrajit Prasad; Arvinda Hanumanthapura Ramalingaiah; Jitender Saini; Dhritiman Chakrabarti

doi:10.1055/s-0045-1806849

Indian Journal of Radiology and Imaging, Table of Contents

CC BY-NC-ND 4.0 · Indian J Radiol Imaging
DOI: 10.1055/s-0045-1806849

Original Article

The Falcate Artery: Its Dynamics in Vasospasm

Abhishek Kotwal

¹Department of Radiodiagnosis, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India

,

Ansan Joseph

²Department of Neuroimaging and Interventional Neuroradiology, Sri Ramachandra institute for Higher Education and Research, Chennai, Tamil Nadu, India

,

Karthik Kulanthaivelu

²Department of Neuroimaging and Interventional Neuroradiology, Sri Ramachandra institute for Higher Education and Research, Chennai, Tamil Nadu, India

,

Richa Singh Chauhan

³Department of Radiodiagnosis, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India

,

Chandrajit Prasad

⁴Department of Neuroimaging and Interventional Neuroradiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India

,

Arvinda Hanumanthapura Ramalingaiah

⁴Department of Neuroimaging and Interventional Neuroradiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India

,

Jitender Saini

⁴Department of Neuroimaging and Interventional Neuroradiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India

,

Dhritiman Chakrabarti

⁵Department of Neuroanaesthesia, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India

› Author Affiliations

Abstract

Background

Moyamoya disease demonstrates angiographically enlarged anterior falcine artery (AFA) participating in anastomotic dural–pial collateralization along parasagittal locations. It is conceivable that in vasospasm following subarachnoid hemorrhage (SAH-V), this AFA may responsively enlarge to perfuse ischemic parenchyma. We investigate the angiographic attributes of AFA and its reactive functions in post-SAH-V.

Materials and Methods

A retrospective assessment of clinical and imaging data was done on patients with SAH with angiographic vasospasm (modified Fisher scale [mFS]: 1–4; graded subjectively as either “mild”/“moderate”/“severe”), who were offered nimodipine infusion chemical angioplasty (NCA). Digital subtraction (biplane) angiography (DSA) characteristics studied were visibility of AFA and its length from the skull base. The mixed effect analysis methodology was used for comparison.

Results

The AFA was visualized in 59% of patients (n = 100; age: 26–75 years; M:F = 48:52;) in pre-NCA angiograms (47% in angiographic control group; p = 0.004). A trend was noted tending to longer AFA lengths in SAH-V in cases of anterior communicating artery (ACom) aneurysms (p = 0.7237), and higher mFS (increased by ∼0.99 cm in mFS grade 4; p = 0.276). Post-NCA, the average reduction in AFA length in “mild,” “moderate,” and “severe” subgroups of vasospasm was 0.49, 0.78, and 0.81 cm, respectively. The length reduction for AFA after NCA was statistically significant (p < 0.001). An 18.9% increase in the odds of vasospasm was estimated per centimeter increase in AFA length.

Conclusion

The AFA is angiographically demonstrable in greater than 58% of SAH-V cases. On DSA, the AFA was substantially longer and prominent in SAH-V cases and its post-NCA dimensions reduced, especially with severe vasospasm.

Keywords

falx artery - vasospasm - nimodipine - subarachnoid hemorrhage

Full Text

References

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