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Rete middle cerebral artery anomalies: a unifying name, case series, and literature review

 Kwang-Chun Cho  ;  Jung-Jae Kim  ;  Chang-Ki Jang  ;  Chang-Ki Hong  ;  Jin-Yang Joo  ;  Yong Bae Kim 
 JOURNAL OF NEUROSURGERY, Vol.131(2) : 453-461, 2019 
Journal Title
Issue Date
Adult ; Angiography, Digital Subtraction*/methods ; Female ; Humans ; Male ; Middle Aged ; Middle Cerebral Artery/abnormalities* ; Middle Cerebral Artery/diagnostic imaging* ; Middle Cerebral Artery/surgery
ACA = anterior cerebral artery ; ACoA = anterior communicating artery ; DSA = digital subtraction angiography ; ECA = external carotid artery ; ICA = internal carotid artery ; ICH = intracerebral hemorrhage ; IVH = intraventricular hemorrhage ; MCA = middle cerebral artery ; MCA anomaly ; SAH = subarachnoid hemorrhage ; TIA = transient ischemic attack ; middle cerebral artery ; moyamoya phenomenon ; rete MCA ; twiglike MCA ; vascular disorders
OBJECTIVE: Rete middle cerebral artery (MCA) is extremely rare and has not been frequently discussed. Rete MCA is a weblike anomaly of the MCA that does not coalesce and forms a prominent, large single branch from the plexiform vessels in the fetal stage. The purpose of this study was to further elucidate the clinical and radiological characteristics of patients with rete MCA.

METHODS: A total of 2262 cerebral digital subtraction angiography procedures were performed on 1937 patients at the authors' institution from February 2013 to May 2017. Data analysis included age, sex, clinical symptoms, underlying diseases, coexisting cerebral arterial anomalies, and operative methods and findings.

RESULTS: Rete MCAs were found in 13 patients, and the incidence of this anomaly was 0.67% (13 of 1937) in this study. Of the 13 patients, 3 had hemorrhagic strokes, 6 had ischemic strokes, and 4 had no symptoms. Eight patients underwent conservative treatment, and 5 patients underwent surgical treatment. Rete MCA is considered a congenital disease of the cerebral vasculature with the possibility of an acquired abnormality, such as an aneurysm, caused by hemodynamic stress. Although an epidemiological survey of rete MCA was not conducted, it is assumed that rete MCA has a high prevalence in Asia. Ischemic and hemorrhagic stroke events are fairly common in rete MCA.

CONCLUSIONS: Clinicians should understand the radiological and clinical features of patients with rete MCA to avoid misdiagnosis and unnecessary treatment. This anomaly should be differentiated from other vascular diseases and patients presenting incidentally should be carefully monitored because of their vulnerability to both hemorrhagic and ischemic strokes.
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Yong Bae(김용배) ORCID logo https://orcid.org/0000-0003-2262-7157
Kim, Jung-Jae(김정재) ORCID logo https://orcid.org/0000-0002-4669-8577
Jang, Chang Ki(장창기) ORCID logo https://orcid.org/0000-0001-8715-8844
Joo, Jin Yang(주진양)
Hong, Chang Ki(홍창기) ORCID logo https://orcid.org/0000-0002-2761-0373
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