Hypoplastic/absent ACA-A1 segment predicts larger basal ganglia infarcts and higher hemorrhage risk after MCA thrombectomy

Hypoplastic/absent anterior cerebral artery A1 segment independently predicted larger basal ganglia infarct volume (β=5.71 cm3, 95% CI 2.86–8.57) and increased hemorrhagic transformation (aOR=3.06, 1.28–7.29) after thrombectomy for MCA occlusion. Retrospective cohort.

• Design: Control cohort (n=300) defined A1–lenticulostriate artery anatomy; retrospective thrombectomy cohort (n=236) with MCA occlusion, A1 status assessed on pre-intervention CTA.
• Anatomical basis: Hypoplastic/absent A1 associated with reduced medial lenticulostriate artery presence (6.1% vs 20.7%, P=0.016) and more lateral LSAs.
• Limitation: Single-center retrospective design, small A1-hypoplasia subgroup (n=36), and anatomical findings from a separate control cohort; no external validation.

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