A review of the anatomy of the middle cerebral artery for the era of thrombectomy: a radiologic tool based on CT angiography and perfusion CT

Abstract

The middle cerebral artery (MCA) is one of the principal intracranial vessels. It is also the one that is most often involved in ischemic cerebrovascular disease, which accounts for a significant volume of brain imaging tests. With recent updates in the management of ischemic stroke (including intravascular treatment in increasingly distal vessels and in an increasingly widening spectrum of patients), it is becoming more important to know the details of the cerebral vascular anatomy to reach accurate diagnoses quickly and thereby improve patients' prognoses. For these reasons, we present this anatomic review of the MCA, reviewing its segments and anatomic limits, its branching patterns, and its anatomic variants. We also provide a radiologic tool based on correlations between CT angiography and perfusion CT to facilitate the identification of the points of occlusion within the branches of the MCA, taking into account its different variants.

Keywords: Anatomy; Anatomía; Angio-TC; Arteria cerebral media; CT angiography; Ictus; Middle cerebral artery; Perfusion CT; Stroke; TC perfusión.