Variants of the circle of Willis in ischemic stroke patients

De, Jolanda; Ciacciarelli, Antonio; Tessitore, Agostino; Buonomo, Orazio; Calzoni, Andrea; Francalanza, Isabella; Dell’Aera, Cristina; Cosenza, D.; Currò, Carmelo Tiberio; Granata, Francesca; Vinci, Sergio Lucio; Trimarchi, Giuseppe; Toscano, Antonio; Musolino, Rosa Fortunata; Spina, Paolino La

doi:10.1007/s00415-021-10454-4

Cited by 36 publications

(22 citation statements)

References 11 publications

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“…Among 702/1131 ischemic stroke patients only 21.8% had variants in both anterior and posterior cW and a unilateral FPCA was found in 137/1131 cases (12.11%) [ 32 ]. A different study found unilateral FPCAs in 25.6% of cases and bilateral FPCAs in just 7.7% of cases [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

The Fetal Type of Posterior Cerebral Artery

et al. 2023

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Background and Objectives: Anatomical variations of the arterial circle of Willis (cW) are common. A posterior cerebral artery (PCA) fed mostly or exclusively from the internal carotid artery is a fetal PCA (FPCA), partial (p-FPCA), or full/complete (f-FPCA), respectively. Because FPCA occurs in different anatomical configurations of the cW sides, we aimed to document in detail these morphological possibilities of FPCA within the cW. Materials and Methods: FPCAs were documented on a retrospective set of 139 computed tomography angiograms. Results: FPCAs were found in thirteen cases, nine males and four females. In 7/13 cases there were two modified sides of the cW. In 5/13 cases there were three altered sides of the cW. Another case with FPCA showed four altered sides of the cW. In 10/13 cases, FPCA was unilateral and in the other three cases it was bilateral. Compared to the overall group, unilateral p-FPCAs were found in 1.43%, while unilateral f-FPCAs were found in 5.75%. A bilateral p-FPCA-f-FPCA combination was found in 0.71% and a bilateral f-FPCA-f-FPCA combination occurred in 1.43%. An anatomically isolated ICA was found in just one case with bilateral f-FPCA (0.71%). In 7/13 FPCA cases there were arterial variants exclusively in the posterior cW. In the other 6/13 FPCA cases, there were variants in both anterior and posterior circulation. There were no statistically significant associations of FPCA with sex or age. The higher prevalence of right-sided FPCA was not statistically significant. Conclusions: Anatomical assessments of cW should be performed on a case-by-case basis, as they may correspond to different cW morphologies.

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Section: Discussionmentioning

confidence: 99%

The Fetal Type of Posterior Cerebral Artery

et al. 2023

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“…Incomplete CoW increases the risk of AIS and TIA in patients with ICAS because cerebral perfusion cannot be maintained [ 21 , 51 ]. In our study, incomplete symptomatic side P-CoW was observed in 74.2% (72/97) of the study participants and was consistent with a previous report in the study of Chinese population [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…The relationship between the CoW variants and acute ischemia is unclear. De Caro et al reported a higher prevalence of CoW variants in stroke patients [ 21 ]. Furthermore, recent studies have shown that geometric variations of the intracranial vessels affected the formation and progression of ICAS [ 22 , 23 ].…”

Section: Introductionmentioning

confidence: 99%

The incomplete circle of Willis is associated with vulnerable intracranial plaque features and acute ischemic stroke

Wang

Shen

Zhao

et al. 2023

Journal of Cardiovascular Magnetic Resonance

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Background The circle of Willis (CoW) plays a significant role in intracranial atherosclerosis (ICAS). This study investigated the relationship between different types of CoW, atherosclerosis plaque features, and acute ischemic stroke (AIS). Methods We investigated 97 participants with AIS or transient ischemic attacks (TIA) underwent pre- and post-contrast 3T vessel wall cardiovascular magnetic resonance within 7 days of the onset of symptoms. The culprit plaque characteristics (including enhancement grade, enhancement ratio, high signal in T1, irregularity of plaque surface, and normalized wall index), and vessel remodeling (including arterial remodeling ratio and positive remodeling) for lesions were evaluated. The anatomic structures of the anterior and the posterior sections of the CoW (A-CoW and P-CoW) were also evaluated. The plaque features were compared among them. The plaque features were also compared between AIS and TIA patients. Finally, univariate and multivariate regression analysis was performed to evaluate the independent risk factors for AIS. Result Patients with incomplete A-CoW showed a higher plaque enhancement ratio (P = 0.002), enhancement grade (P = 0.01), and normalized wall index (NWI) (P = 0.018) compared with the patients with complete A-CoW. A higher proportion of patients with incomplete symptomatic P-CoW demonstrated more culprit plaques with high T1 signals (HT1S) compared with those with complete P-CoW (P = 0.013). Incomplete A-CoW was associated with a higher enhancement grade of the culprit plaques [odds ratio (OR):3.84; 95% CI: 1.36–10.88, P = 0.011], after adjusting for clinical risk factors such as age, sex, smoking, hypertension, hyperlipemia, and diabetes mellitus. Incomplete symptomatic P-CoW was associated with a higher probability of HT1S (OR:3.88; 95% CI: 1.12–13.47, P = 0.033), after adjusting for clinical risk factors such as age, sex, smoking, hypertension, hyperlipemia, and diabetes mellitus. Furthermore, an irregularity of the plaque surface (OR: 6.24; 95% CI: 2.25–17.37, P < 0.001), and incomplete symptomatic P-CoW (OR: 8.03, 95% CI: 2.43–26.55, P = 0.001) were independently associated with AIS. Conclusions This study demonstrated that incomplete A-CoW was associated with enhancement grade of the culprit plaque, and incomplete symptomatic side P-CoW was associated with the presence of HT1S of culprit plaque. Furthermore, an irregularity of plaque surface and incomplete symptomatic side P-CoW were associated with AIS.

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“…In a series of stroke and control patients undergoing vascular imaging (magnetic resonance angiography, computed tomography angiography (CTA), and/or digital subtraction angiography (DSA)), up to 62% of patients presented vascular variants, with 22% having variants of both the anterior and posterior circulation. The most prevalent vascular variant was agenesis/hypoplasia of the ACA (18%), followed by the unilateral fetal type of posterior cerebral artery (12%) [ 22 ]. In a series of 376 stroke patients, the group with the poorest prognosis had incomplete anterior and/or posterior segment of the circle of Willis [ 23 ].…”

Section: Collateral Systems In Cases Of Arterial Occlusionmentioning

confidence: 99%

Collateral Supply in Preclinical Cerebral Stroke Models

Bonnin

Kubis

Charriaut‐Marlangue

2021

Transl. Stroke Res.

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Enhancing the collateral blood supply during the acute phase of cerebral ischemia may limit both the extension of the core infarct, by rescuing the penumbra area, and the degree of disability. Many imaging techniques have been applied to rodents in preclinical studies, to evaluate the magnitude of collateral blood flow and the time course of responses during the early phase of ischemic stroke. The collateral supply follows several different routes at the base of the brain (the circle of Willis) and its surface (leptomeningeal or pial arteries), corresponding to the proximal and distal collateral pathways, respectively. In this review, we describe and illustrate the cerebral collateral systems and their modifications following pre-Willis or post-Willis occlusion in rodents. We also review the potential pharmaceutical agents for stimulating the collateral blood supply tested to date. The time taken to establish a collateral blood flow supply through the leptomeningeal anastomoses differs between young and adult animals and between different species and genetic backgrounds. Caution is required when transposing preclinical findings to humans, and clinical trials must be performed to check the added value of pharmacological agents for stimulating the collateral blood supply at appropriate time points. However, collateral recruitment appears to be a rapid, beneficial, endogenous mechanism that can be stimulated shortly after artery occlusion. It should be considered a treatment target for use in addition to recanalization strategies.

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Variants of the circle of Willis in ischemic stroke patients

Cited by 36 publications

References 11 publications

The Fetal Type of Posterior Cerebral Artery

The Fetal Type of Posterior Cerebral Artery

The incomplete circle of Willis is associated with vulnerable intracranial plaque features and acute ischemic stroke

Collateral Supply in Preclinical Cerebral Stroke Models

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