الفهرس 
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Abstract
Stroke occurs when the blood supply to the brain is cut off, usually due to a blood vessel burst or being blocked by a clot. This reduces the supply of oxygen and nutrients, causing brain tissue damage. The effects of a stroke depend on which part of the brain is injured.
Recent randomized trials have revealed the efficacy of mechanical thrombectomy (MT) in acute ischemic stroke due to large vessel occlusions. The increasing number of interventions performed entails an inevitable parallel rise in deleterious complications. Potential complications during the procedure include access-site problems, device-related complications (vasospasm, arterial perforation and dissection), and embolization to new vessel territories. Among these complications, arterial perforation can lead to significant neurological deterioration and higher mortality.
The standard technique in MT is to pass the presumed thrombus with a microguidewire not overtly seen angiographically and to advance the microcatheter over the microguidewire to the non-visualized distal course of the arterial distribution. These represent blind manipulations and so entail an ineluctable risk of arterial perforation. We paid attention to the fact that evaluating the contralateral vasculature on cross-sectional imaging might provide clues to what the occluded vasculature may have in store, since symmetry is an integral part of the bianatomy. Recognition of the local arterial running pattern for the occluded lesion and distal territory would allow for more confident maneuvering while crossing the occlusion site and contribute to preventing inadvertent perforations.
TOF MRA is a frequently used imaging modality in the evaluation of acute stroke patients and can demonstrate occlusion in the major intracranial arteries.
Our aim in this study was to investigate the frequency of “mirror images” of the middle cerebral artery (MCA) and to evaluate whether the geometric features apparent from the contralateral side can be used as surrogates for predicting the running course of occluded arteries.
This cross-sectional registry-based study was conducted on MRI imaging of 375 patients collected from Radiology Department in Ain Shams University Hospitals in a period of 6 months starting from March 2024 till September 2024 after exclusion of 15 patients due to following reasons; anatomical variations and difficult differentiation between true bifurcation and early cortical branch.
We evaluated images in the anterior-posterior view. The main anatomical features assessed were the following 4 parameters: division pattern of M2, early frontal/temporal cortical branch pattern, length, and running course of the M1.
In 64.3% (bifurcation type, 56%; trifurcation type, 8.3%), branching patterns of the left and right M1 were symmetrical. Early frontal and/or temporal branches were observed in 73.6%, and the presence/absence of early branches was symmetrical in 58.7% cases. In 24.8%, M1 was classified as short M1, and classifications were identical between hemispheres in 78.4%. Running course of the M1 was symmetrical in 69.1%. Two or more parameters were symmetrical in 234 cases (62.4%).
The symmetry of bilateral M1-2 structures was demonstrated in most cases from the perspectives of the 4 parameters of division pattern, early cortical branch, length, and course. The contralateral MCA configuration on TOF-MRA before MT may allow more reliable and safer maneuvering during MT, particularly when the neurointerventionalist advances devices through a site of occlusion, and may reduce the risk of inadvertent perforations.