Anatomical variations in intracranial arteries: Does gender matter?

Objectives Anatomical variations in cerebral arterial morphology are common and can have significant clinical implications. Digital subtraction angiography (DSA) serves as a crucial tool for visualizing these variations and guiding interventions. This retrospective study aimed to analyze intracranial arterial variations using DSA and to explore their demographic details and review their clinical significance. Materials and Methods A total of 394 patients who underwent DSA for various indications were included in the study. Demographic data, comorbidities, and clinical symptoms were collected and analyzed. DSA images were reviewed to assess arterial morphology, including normal variants and variations such as fenestrations, duplications, hypoplasia, and aplasia. The patients were divided into two groups (male and female) based on gender. Results The majority of patients were in the age groups of 51–60 years and >60 years, with a male preponderance (64.3%). Arterial variations were observed in 54.31%, with the posterior cerebral artery (PCA) being the most commonly affected followed by the anterior cerebral artery (ACA) and middle cerebral artery (MCA). Fetal PCA was observed in 21%, often bilateral. Hypoplastic and aplastic ACA segments were found in 11.93% and 5.1% of subjects, respectively. MCA trifurcation was seen in 10.4% of subjects. Anatomic variation in PCA was significantly higher in females, whereas ACA variations were more common in males. Conclusion Fetal PCA, hypoplasia or aplasia of proximal ACA (A1) were the most common anatomical variations. Gender-specific anatomical variations were also identified with females having more predisposition for PCA variations whereas ACA and vertebral artery variations were more frequent amongst males.