Intracranial arteries (variants)

Last revised by Ammar Ashraf on 6 Dec 2023

Intracranial arterial variants, of which there are many, are collectively common. Their clinical significance may be variable but knowledge and recognition of these variants is fundamental, especially if surgical or endovascular treatments (e.g. for acute stroke, aneurysms or other vascular pathologies) are being considered.

Variant anatomy

Anatomical variations in intracranial arterial anatomy include:

Internal carotid artery
Vertebral and basilar arteries
Anterior cerebral artery
Middle cerebral artery
Posterior cerebral artery
Persistent carotid-vertebrobasilar artery anastomoses 

Persistent carotid-vertebrobasilar anastomoses including: 

Cases and figures

  • Figure 1: common variants of the COW
  • Case 1: ACA fenestration
  • Case 2: persistent trigeminal artery
  • Case 3: accessory MCA
  • Case 4: aplastic A1
  • Case 5: aplastic A1
  • Case 6: basilar artery fenestration
  • Case 7: trifurcated left MCA
  • Case 8: aplastic right A1
  • Case 9: aplastic right A1 and bilateral fetal posterior communicating arteries on MRA
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