ABSTRACT
Advances in imaging and materials technology have expanded the array of pathologies treatable through less invasive endovascular approaches. The resultant benefit to the patient manifested by increased interventional success rates and reduced morbidity and mortality cannot be overstated. However, the utility of even the most advanced biplanar machine with 3D rotational capabilities is limited without a thorough understanding of the craniocerebral angiographic anatomy. This understanding must, of necessity, include the significant arterial anastomoses and collateral circulatory patterns that should be considered during any intervention. Collateral circulation may prevent significant neurologic deficit should parent artery occlusion (PAO) be required. That said, known circulatory anastomoses could result in infarct distal to the area of embolization or PAO. The purpose of this chapter is to provide an in-depth review of the normal cerebrovascular angiographic anatomy as well as the significant internal, external, and vertebrobasilar anastomoses. Additionally, high-quality gross anatomic specimens will be shown with the basic angiogram to emphasize the importance of surrounding neurologic structures. The importance of the contribution of individual anatomy in the formulation of any treatment plan will also be emphasized. Because thorough reviews of anatomic variants have been provided elsewhere (1-5), only brief descriptions will be highlighted where considered relevant.
