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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2025; 35(04): 582-588
DOI: 10.1055/s-0045-1806849
Original Article

The Falcate Artery: Its Dynamics in Vasospasm

Abhishek Kotwal
1   Department of Radiodiagnosis, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India
,
Ansan Joseph
2   Department of Neuroimaging and Interventional Neuroradiology, Sri Ramachandra institute for Higher Education and Research, Chennai, Tamil Nadu, India
,
Karthik Kulanthaivelu 
2   Department of Neuroimaging and Interventional Neuroradiology, Sri Ramachandra institute for Higher Education and Research, Chennai, Tamil Nadu, India
,
Richa Singh Chauhan 
3   Department of Radiodiagnosis, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
,
Chandrajit Prasad
4   Department of Neuroimaging and Interventional Neuroradiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
,
Arvinda Hanumanthapura Ramalingaiah
4   Department of Neuroimaging and Interventional Neuroradiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
,
Jitender Saini
4   Department of Neuroimaging and Interventional Neuroradiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
,
Dhritiman Chakrabarti
5   Department of Neuroanaesthesia, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Funding None.
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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

Data Availability Statement

The data will be made available upon reasonable request to authors.


Authors' Contributions

All the authors have made substantial contributions to all of the following: (1) the conception and design of the study, acquisition of data, or analysis and interpretation of data; (2) drafting the article or revising it critically for important intellectual content; and (3) final approval of the version to be submitted.


Ethical Approval

The study was approved by the institute's ethical board.




Publikationsverlauf

Artikel online veröffentlicht:
31. März 2025

© 2025. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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