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Reddan T, Malouf M, Venugopal P, Powell J. Pre-operative transcranial Doppler ultrasound assessment of cerebral collateral circulation in children undergoing veno-arterial extracorporeal membrane oxygenation or cardiac surgery. J Med Radiat Sci 2024. [PMID: 39668772 DOI: 10.1002/jmrs.845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Accepted: 11/30/2024] [Indexed: 12/14/2024] Open
Abstract
Children requiring veno-arterial extracorporeal membrane oxygenation (VA ECMO) or cardiac surgery often undergo cervical cannulation or carotid artery clamping, which can interrupt cerebral circulation. Inadequate collateral flow through the circle of Willis (CoW) may lead to cerebral ischaemia within the vascular territory and/or watershed regions. Pre-cannulation survey of the CoW using transcranial Doppler (TCD) ultrasound may be performed to predict and plan neuroprotection. It is important to note in this article TCD refers to Duplex or colour coded trans-cranial Doppler (TCCD) using radiology-based machines, which is distinct from the more traditional trans-cranial Doppler technique that does not incorporate a B-mode image. This article describes our technique, in use since 2019, to guide surgical approaches and neuroprotective measures when an incomplete CoW is identified. High-end radiology-based ultrasound platforms and various transducers are used to assess brain morphology and haemorrhage through the anterior fontanelle in neonates. TCD is performed with the highest frequency transducer possible, utilising Doppler imaging to visualise cerebral arteries. Manual carotid compression can be used to functionally assess collateral flow when segments appear aplastic or hypoplastic. Potential pitfalls include mistaking the anterior choroidal artery for a hypoplastic posterior communicating artery (PCommA). Since implementing this protocol 5 years ago, no catastrophic infarcts related to cervical cannulation have occurred. This technique provides a practical solution for pre-operative assessment of cerebral collateral circulation in children undergoing VA ECMO or cardiac surgery, allowing for consideration of neuroprotective measures and improving patient safety.
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Affiliation(s)
- Tristan Reddan
- Medical Imaging and Nuclear Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Michael Malouf
- Medical Imaging and Nuclear Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Prem Venugopal
- Queensland Paediatric Cardiac Service, Children's Health Queensland, South Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Jennifer Powell
- Medical Imaging and Nuclear Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- QScan Radiology Clinics, Brisbane, Queensland, Australia
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2
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Ahmad AF, Galassi FM, Burlakoti A, Vaccarezza M, Papa V. Human cerebral blood supply via circulus arteriosus cerebri: A scoping review on its variations and clinical implications. Heliyon 2024; 10:e32648. [PMID: 38975214 PMCID: PMC11225744 DOI: 10.1016/j.heliyon.2024.e32648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 06/06/2024] [Accepted: 06/06/2024] [Indexed: 07/09/2024] Open
Abstract
Background Circulus arteriosus cerebri (CAC), responsible for supplying blood to the brain, presents anatomical variations that have been associated with both haemorrhagic and ischemic strokes. Therefore, it is crucial to conduct comprehensive investigations and comparisons of the diverse variant components of the CAC, published in various journals, and analyze them to identify individuals at risk of cerebrovascular pathologies, thereby ensuring enhanced and timely treatment. Methods A scoping review according to the five-stage protocol by Arksey and O'Malley was performed between February and June 2023. Seven hundred and seventy-seven records were initially identified, and a total of 51 studies were finally included. Results This scoping review focuses on the anatomical variations of the CAC and their clinical implications on cerebrovascular disease and includes more original articles than review s. Consistent with previous findings, most of the records included small populations or samples, while only three records reported larger populations. Surprisingly, the populations enclosed in the included records consisted of autopsied cadaveric specimens more than living subjects. Finally, the qualitative analysis highlighted three main themes concerning the relationship between the normal CAC morphology and the cerebrovascular disease onset as well as the variant CAC morphology and its main features that might be also involved in these diseases. Finally, techniques that can be used to measure CAC have also been assessed. Conclusion Variations in the CAC, more common in the posterior part, with genetic and environmental factors influencing these variations impact cerebrovascular disorders. Understanding variants components of CAC can aid in improving brain surgeries and post-stroke care.
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Affiliation(s)
- Adilah F. Ahmad
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, Perth WA, Australia
| | - Francesco M. Galassi
- Department of Anthropology, Faculty of Biology and Environmental Protection, University of Lodz, Lodz, Poland
| | - Arjun Burlakoti
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Mauro Vaccarezza
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, Perth WA, Australia
- Curtin Health Innovation Research Institute (CHIRI), Curtin University, Bentley, Perth WA, Australia
- Department of Environmental and Preventive Sciences, University of Ferrara, Ferrara, Italy
| | - Veronica Papa
- Forensic Anthropology, Paleopathology and Bioarchaeology (FAPAB) Research Center, Avola, Italy
- Department of Economics, Law, Cybersecurity, and Sports Sciences, University of Naples "Parthenope," Naples, Italy
- School of Science, Engineering and Health, University of Naples "Parthenope," Naples, Italy
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Gyöngyösi Z, Belán I, Nagy E, Fülesdi Z, Farkas O, Végh T, Hoksbergen AW, Fülesdi B. Incomplete circle of Willis as a risk factor for intraoperative ischemic events during carotid endarterectomies performed under regional anesthesia - A prospective case-series. Transl Neurosci 2023; 14:20220293. [PMID: 37465373 PMCID: PMC10350890 DOI: 10.1515/tnsci-2022-0293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/08/2023] [Accepted: 05/26/2023] [Indexed: 07/20/2023] Open
Abstract
Background The role of the willisian collaterals during carotid endarterectomies (CEAs) is a debated issue. The aim of the present work was to test whether an incomplete or non-functional circle of Willis (CoW) is a risk factor for ischemic events during CEA. Patients and methods CEAs were performed under local anesthesia. Patients were considered symptomatic (SY) if neurological signs appeared after the cross-clamping phase. In SY patients shunt insertion was performed. CoW on CT angiograms (CTa) were analyzed offline and categorized as non-functional (missing or hypoplastic collaterals) or functional collaterals by three neuroradiologists. Near-infrared spectroscopy (NIRS) was performed throughout the procedure. Results Based on CTa, 67 incomplete circles were found, 54 were asymptomatic (ASY) and 13 were SY. No complete CoW was found among the SY patients. Significant differences could be detected between incomplete and complete circles between ASY and SY groups (Chi-square: 6.08; p = 0.013). The anterior communicating artery was missing or hypoplastic in 5/13 SY cases. There were no cases of the non-functional anterior communicating arteries in the ASY group (Chi-square: 32.9; p = 10-8). A missing or non-functional bilateral posterior communicating artery was observed in 9/13 SY and in 9/81 ASY patients (Chi-square: 24.4; p = 10-7). NIRS had a sensitivity of 76.9% and a specificity of 74.5% in detecting neurological symptoms. Conclusions Collateral ability of the CoW may be a risk factor for ischemic events during CEAs. Further studies should delineate whether the preoperative assessment of collateral capacity may be useful in decision-making about shunt use during CEA.
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Affiliation(s)
- Zoltán Gyöngyösi
- Department of Anesthesiology and Intensive Care, University of Debrecen, Debrecen, Hungary
| | - Ivett Belán
- Department of Radiology, University of Debrecen, Debrecen, Hungary
| | - Edit Nagy
- Department of Radiology, University of Debrecen, Debrecen, Hungary
| | - Zsófia Fülesdi
- Department of Radiology, University of Debrecen, Debrecen, Hungary
| | - Orsolya Farkas
- Department of Anesthesiology and Intensive Care, University of Debrecen, Debrecen, Hungary
| | - Tamás Végh
- Department of Anesthesiology and Intensive Care, University of Debrecen, Debrecen, Hungary
| | - Arjan Willem Hoksbergen
- Department of Vascular Surgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Béla Fülesdi
- Department of Anesthesiology and Intensive Care, University of Debrecen, Debrecen, Hungary
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Ma S, Zhang M, Qu H, Cheng Y, Du S, Fan J, Yao Q, Zhang X, Chen M, Zhang N, Shi K, Huang Y, Zhan S. Combination of High-Density Lipoprotein Cholesterol and Lipoprotein(a) as a Predictor of Collateral Circulation in Patients With Severe Unilateral Internal Carotid Artery Stenosis or Occlusion. J Clin Neurol 2022; 18:14-23. [PMID: 35021272 PMCID: PMC8762497 DOI: 10.3988/jcn.2022.18.1.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/12/2021] [Accepted: 08/18/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE Collateral circulation is considered an important factor affecting the risk of stroke, but the factors that affect collateral circulation remain unclear. This study was performed to identify the factors associated with collateral circulation, especially blood lipids. METHODS The study involved patients who had undergone digital subtraction angiography and were confirmed as having severe unilateral stenosis or occlusion of the internal carotid artery (ICA). We classified the collateral circulation status of each patient as good (Grade 3 or 4) or poor (Grade 0, 1, or 2) according to the grading system of the American Society of Interventional and Therapeutic Neuroradiology/American Society of Interventional Radiology. We collected data on patients' characteristics and identified the factors that affect collateral circulation. RESULTS This study included 212 patients. The multivariate logistic regression analysis showed that the high-density lipoprotein cholesterol (HDL-C) concentration and a complete anterior half of the circle of Willis were independent protective factors for good collateral circulation, whereas elevated lipoprotein(a) [Lp(a)] and serum creatinine concentrations were independent risk factors for good collateral circulation. The area under the receiver operating characteristics curve (AUC) was 0.68 (95% confidence interval [CI], 0.61-0.76) for HDL-C and 0.69 (95% CI, 0.62-0.76) for Lp(a). A binary logistic regression model analysis of the joint factor of HDL-C and Lp(a) yielded an AUC of 0.77 (95% CI, 0.71-0.84). CONCLUSIONS In patients with severe unilateral ICA stenosis or occlusion, the combination of HDL-C and Lp(a) is a useful predictor of collateral circulation.
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Affiliation(s)
- Shuyin Ma
- Department of Neurology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Meijuan Zhang
- Department of Neurology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Huiyang Qu
- Department of Neurology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yuxuan Cheng
- Department of Neurology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shuang Du
- Department of Neurology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jiaxin Fan
- Department of Neurology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qingling Yao
- Department of Neurology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiaodong Zhang
- Department of Neurology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Mengying Chen
- Department of Neurology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Nan Zhang
- Department of Neurology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Kaili Shi
- Department of Neurology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yizhou Huang
- Department of Neurology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shuqin Zhan
- Department of Neurology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
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Orosz L, Gyöngyösi Z, Susán Z, Siró P, Hoksbergen AW, Csiba L, Fülesdi B. Assessment of malformations, variations and diameters of vessels forming the circle of Willis - An autopsy study in a non-cerebrovascular cohort. Transl Neurosci 2022; 13:398-406. [PMID: 36406464 PMCID: PMC9644724 DOI: 10.1515/tnsci-2022-0253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/05/2022] [Accepted: 09/15/2022] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND A PURPOSE The collateral capacity of the circle of Willis (CoW) may play an important role in the development of ischemic strokes. The occurrence of classical polygon shows wide geographical variations and morphological data on diameters of the Willisian collaterals are scarce. We aimed to assess CoW variations and vessel diameters in a Central European cohort. SUBJECTS AND METHODS CoWs were removed during routine autopsy. The morphological pattern of the circles was recorded. The prepared circles were then put between two glass plates and tightly compressed. The length of the vessels and half of the circumference were measured under a light microscope enabling measurement with an approximation of 0.1 mm. Vessel diameters were calculated from vessel circumference. RESULTS A total of 110 circles were analysed. Incomplete circles (missing one or two segments of CoW) were found in 25 cases (22.7%). Any forms of anatomical variations were detected in 14 cases (12.7%). When applying the <1 mm diameter threshold for analysis, 36 anterior communicating arteries (32.7%), 53 right posterior communicating arteries (48.2%), 73 left posterior communicating arteries (66.4%) and 18 posterior communicating arteries (16.3%) on both the sides were considered hypoplastic. CONCLUSIONS In patients without stroke in their history, complete CoW may be present in >60% of the cases. Our diameter data may serve as reference values for the Central-European population.
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Affiliation(s)
- László Orosz
- Department of Surgery, University of Debrecen, Debrecen, Hungary
| | - Zoltán Gyöngyösi
- Department of Anesthesiology and Intensive Care, University of Debrecen, H-4032, Nagyerdei krt. 98, Debrecen, Hungary
| | - Zsolt Susán
- Department of Surgery, University of Debrecen, Debrecen, Hungary
| | - Péter Siró
- Department of Anesthesiology and Intensive Care, University of Debrecen, H-4032, Nagyerdei krt. 98, Debrecen, Hungary
| | | | - László Csiba
- Department of Neurology, Faculty of Medicine, University of Debrecen, H-4032, Nagyerdei krt. 98, Debrecen, Hungary
| | - Béla Fülesdi
- Department of Anesthesiology and Intensive Care, University of Debrecen, H-4032, Nagyerdei krt. 98, Debrecen, Hungary
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Wang N, Chen Z, Zhang S, Liu Z, Xie P, Li J, Wang J, Chen L, Wang L. Leptomeningeal collateral flow in patients with middle cerebral artery occlusion assessed by transcranial Doppler. J Neuroimaging 2021; 32:179-186. [PMID: 34648213 DOI: 10.1111/jon.12937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE To explore the application value and clinical significance of transcranial Doppler(TCD)in assessing leptomeningeal collateral flow (LMF) status in patients with unilateral middle cerebral artery (MCA) occlusion. METHODS Medical records of patients with unilateral MCA occlusion confirmed by digital subtraction angiography (DSA) were analyzed retrospectively. The patients were divided into three groups according to LMF status, and the laboratory and imaging results were collected. Cerebral blood flow velocity (CBFV) of MCA, anterior cerebral artery (ACA), and posterior cerebral artery (PCA) on the affected side (ipsilateral, i) and the healthy side (contralateral, c) were measured and recorded by TCD. The results of CBFV changes detected by TCD were compared with those of DSA, and the correlation between CBFV changes and LMF status was analyzed. RESULTS Eighty-four patients with unilateral MCA occlusion were included. CBFViACA and CBFViPCA were significantly faster than CBFVcACA and CBFVcPCA in patients with good LMF status (p<.05). There was a significant positive correlation between CBFViACA and LMF status (r = 0.697, p<.001). There was statistical significance in receiver operating characteristic curve analysis of CBFViACA and CBFViPCA (p<.05). The area under the curve of CBFViACA and CBFViPCA, respectively, was 0.879 and 0.678, and the best cutoff value was 82 and 60.5 cm/s. CONCLUSIONS TCD can assess LMF status by detecting the changes of flow velocity of intracranial vessels. CBFV of ACA and PCA in patients with MCA occlusion is significantly correlated with LMF status by DSA. Assessing LMF status, CBFViACA, CBFViACA/CBFVcACA, and CBFViACA/CBFViMCA has the great diagnostic value, which is of great significance in guiding MCA occlusion patients to choose individualized treatment.
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Affiliation(s)
- Na Wang
- Department of Neurology, Second Affiliated Hospital of Harbin Medical University, Harbin, P. R. China
| | - Zhimin Chen
- Department of Neurology, Harbin City Second Hospital, Harbin, P. R. China
| | - Shuai Zhang
- Department of Neurology, Second Affiliated Hospital of Harbin Medical University, Harbin, P. R. China
| | - Zhongshuang Liu
- Department of Stomatology, Shenzhen University General Hospital, Shenzhen, P. R. China
| | - Peng Xie
- Department of Neurosurgery, Second Affiliated Hospital of Harbin Medical University, Harbin, P. R. China
| | - Jie Li
- Department of Neurology, Second Affiliated Hospital of Harbin Medical University, Harbin, P. R. China
| | - Jingyan Wang
- Department of Information Center, Second Affiliated Hospital of Harbin Medical University, Harbin, P. R. China
| | - Lixia Chen
- Department of Neurology, Second Affiliated Hospital of Harbin Medical University, Harbin, P. R. China
| | - Lihua Wang
- Department of Neurology, Second Affiliated Hospital of Harbin Medical University, Harbin, P. R. China
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Abdi M, NavidBakhsh M. Collateral flow at circle of Willis in healthy condition. Perfusion 2021; 37:293-305. [PMID: 33594933 DOI: 10.1177/0267659120987550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Experimental simulation of cerebrovascular system would be very beneficial tool to evaluate millions of human body cascade sequence. The Circle of Willis (CoW) recently named Cerebral Arterial Circle (CAC) is a main loop structure of cerebral circulatory system which positioned at the cranium base. In this research, we investigate cerebral artery flow pattern in cerebral arteries including afferent, Willisian, and efferent arteries of CAC emphasizing on communicating and connecting arteries which are main routes in CAC and as a risky sites when autoregulation is occurred in terminal parts of middle cerebral arteries (MCAs) by PMMA (Polymethyl methacrylate) chip and high quality camera which depict Sequential images. This novelty study analyze flow pattern in CAC that have been challenging subject area for many years which have investigated by scientists yet, because flow pattern in CAC indicate complication progression. This research tries to construct new platform in cerebral circulation analyzing method by reliable experimental in-vitro approach. The outcomes of this study demonstrate that communicating arteries especially anterior communicating artery (ACoA) is main artery in CAC flow distribution.
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Affiliation(s)
- Mohsen Abdi
- School of Mechanical Engineering, Iran University of Science and Technology, Tehran, Iran.,Tissue Engineering and Biological Systems Research Laboratory, School of Mechanical Engineering, Iran University of Science and Technology, Tehran, Iran
| | - Mahdi NavidBakhsh
- School of Mechanical Engineering, Iran University of Science and Technology, Tehran, Iran.,Tissue Engineering and Biological Systems Research Laboratory, School of Mechanical Engineering, Iran University of Science and Technology, Tehran, Iran
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Jacquens A, Shotar E, Bombled C, Glémain B, Sourour NA, Nouet A, Premat K, Lenck S, Degos V, Clarençon F. Is Anatomical Variations a Risk Factor for Cerebral Vasospasm in Anterior Communicating Complex Aneurysms Rupture? Stroke 2020; 51:998-1001. [PMID: 31964285 DOI: 10.1161/strokeaha.119.026661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- One-third of ruptured aneurysms are located on the anterior communicating complex with high prevalence of anatomic variations of this arterial segment. In this study, we hypothesized that anatomic variations of the anterior communicating complex increase the risk of angiographic vasospasm. Methods- Retrospective study of prospectively collected data from a monocentric subarachnoid hemorrhage cohort of patients admitted to neurointensive care between 2002 and 2018. Univariate followed by multivariate logistic regression analysis was used to identify factors associated with angiographic vasospasm. Results- One thousand three hundred seventy-four patients with aneurismal subarachnoid hemorrhage were admitted to our institution; 29.8% (n=410) were related to an anterior communicating complex aneurysm rupture; 9.2% (n=38) of them showed an anterior communicating artery variation. Angiographic vasospasm was diagnosed in 55.6% of this subgroup (vs 28.1%, P=0.003). In the multivariate analysis, external ventricular drain (2.2 [1.32-3.65], P=0.003) and anterior communicating artery variation (2.40 [1.2-4.9], P=0.04) were independently and significantly associated with angiographic vasospasm, while age above 60 years (0.3 [0.2-0.7]; P=0.002) was a protective factor. However, anterior communicating artery variation was not statistically associated with ischemic vasospasm or poor neurological outcome after anterior communicating artery aneurysm rupture. Conclusions- Anatomic variation of anterior communicating artery could be a new biomarker to identify patients at risk to develop angiographic vasospasm post-subarachnoid hemorrhage. External validation cohorts are necessary to confirm these results.
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Affiliation(s)
- Alice Jacquens
- From the Department of Neurosurgical Anesthesiology and Critical Care (A.J., C.B., B.G., V.D.), Pitié-Salpêtrière Hospital, France
| | - Eimad Shotar
- Department of Neuroradiology (E.S., N.-A.S., K.P., S.L., F.C.), Pitié-Salpêtrière Hospital, France
| | - Camille Bombled
- From the Department of Neurosurgical Anesthesiology and Critical Care (A.J., C.B., B.G., V.D.), Pitié-Salpêtrière Hospital, France
| | - Benjamin Glémain
- From the Department of Neurosurgical Anesthesiology and Critical Care (A.J., C.B., B.G., V.D.), Pitié-Salpêtrière Hospital, France
| | - Nader-Antoine Sourour
- Department of Neuroradiology (E.S., N.-A.S., K.P., S.L., F.C.), Pitié-Salpêtrière Hospital, France
| | - Aurélien Nouet
- Department of Neurosurgery (A.N.), Pitié-Salpêtrière Hospital, France
| | - Kevin Premat
- Department of Neuroradiology (E.S., N.-A.S., K.P., S.L., F.C.), Pitié-Salpêtrière Hospital, France.,Sorbonne Université, Paris, France (K.P., V.D., F.C.)
| | - Stephanie Lenck
- Department of Neuroradiology (E.S., N.-A.S., K.P., S.L., F.C.), Pitié-Salpêtrière Hospital, France
| | - Vincent Degos
- From the Department of Neurosurgical Anesthesiology and Critical Care (A.J., C.B., B.G., V.D.), Pitié-Salpêtrière Hospital, France.,Sorbonne Université, Paris, France (K.P., V.D., F.C.).,Groupe de Recherché Clinique BIOFAST (V.D., F.C.)
| | - Frédéric Clarençon
- Department of Neuroradiology (E.S., N.-A.S., K.P., S.L., F.C.), Pitié-Salpêtrière Hospital, France.,Sorbonne Université, Paris, France (K.P., V.D., F.C.).,Groupe de Recherché Clinique BIOFAST (V.D., F.C.)
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9
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Zhou W, Lu M, Li J, Chen F, Hu Q, Yang S. Functional posterior communicating artery of patients with posterior circulation ischemia using phase contrast magnetic resonance angiography. Exp Ther Med 2018; 17:337-343. [PMID: 30651800 PMCID: PMC6307428 DOI: 10.3892/etm.2018.6897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 10/04/2018] [Indexed: 11/05/2022] Open
Abstract
Posterior communicating artery (PCoA) in patients with posterior circulation ischemia (PCI) was quantitatively studied using phase contrast magnetic resonance angiography (PC-MRA). Fifty-one cases who received PC-MRA were included in the study, and divided into the research and control groups. The mean flow volume, mean flow velocity, minimum flow volume, maximum flow volume, minimum flow velocity and maximum flow velocity of the basal artery (BA), bilateral vertebral arteries, internal carotid arteries and functional posterior communicating artery (F-PCoA) were recorded, the peak heights of flow volume and flow velocity were calculated, and the typing of F-PCoA was analyzed, followed by statistical analysis. Fifty-two F-PCoAs were detected, and the median values of mean flow volume, mean flow velocity, cross-sectional area and lumen diameter were 20.31 ml/min, 4.01 cm/sec, 0.08 cm2 and 0.16 cm, respectively. The blood flow curve of F-PCoA showed the sawtooth-like changes, and there could be either unidirectional blood flow or bidirectional blood flow in one cardiac cycle. F-PCoA was divided into the following 3 types: F-PCoA was consistent with anatomical PCoA (A-PCoA), F-PCoA was inconsistent with A-PCoA, and mixed type. In the presence of F-PCoA, both the diameter and cross-sectional area of BA were small, and the maximum flow velocity and peak height of flow volume were reduced, but there was no necessary correlation with the occurrence of PCI. Both flow volume and flow velocity of BA in the research group were reduced, and the forward posterior shunt flow of F-PCoA was increased. Hemodynamic characteristics of F-PCoA can be analyzed via PC-MRA. The forward posterior shunt flow of F-PCoA can provide references for the clinical auxiliary diagnosis.
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Affiliation(s)
- Wei Zhou
- Department of Nuclear Medicine, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong 528308, P.R. China
| | - Minru Lu
- Department of Rehabilitation Medicine, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong 528308, P.R. China
| | - Jun Li
- VIP Medical Center, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong 528308, P.R. China
| | - Feng Chen
- Medical Record Statistics Office, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong 528308, P.R. China
| | - Qiugen Hu
- Department of Radiology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong 528308, P.R. China
| | - Shaomin Yang
- Department of Radiology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong 528308, P.R. China
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10
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Saqqur M, Khan K, Derksen C, Alexandrov A, Shuaib A. Transcranial Doppler and Transcranial Color Duplex in Defining Collateral Cerebral Blood Flow. J Neuroimaging 2018; 28:455-476. [DOI: 10.1111/jon.12535] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 06/18/2018] [Indexed: 12/31/2022] Open
Affiliation(s)
- Maher Saqqur
- Division of Neurology, Department of Medicine; University of Alberta; Edmonton AB Canada
- Neuroscience Institute; Hamad General Hospital Doha Qatar
| | - Khurshid Khan
- Division of Neurology, Department of Medicine; University of Alberta; Edmonton AB Canada
| | - Carol Derksen
- Division of Neurology, Department of Medicine; University of Alberta; Edmonton AB Canada
| | - Andrei Alexandrov
- Department of Neurology; University of Tennessee Health Science Center; Memphis TN USA
| | - Ashfaq Shuaib
- Division of Neurology, Department of Medicine; University of Alberta; Edmonton AB Canada
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Lin W, Ma X, Deng D, Li Y. Hemodynamics in the Circle of Willis with Internal Carotid Artery Stenosis under Cervical Rotatory Manipulation: A Finite Element Analysis. Med Sci Monit 2015; 21:1820-6. [PMID: 26103051 PMCID: PMC4484618 DOI: 10.12659/msm.892822] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The circle of Willis (CoW) plays an important role in cerebral collateral circulation. The hemodynamics changes in the CoW have usually been associated with the internal carotid artery (ICA) stenosis, but whether rotatory manipulation will affect it remains unknown. Material/Methods In this study we attempted to analyze the influence of rotatory manipulation on the hemodynamics in the CoW in models with or without ICA stenosis by means of finite element analysis. For this purpose, the CoW was reasonably simplified and a fluid-solid coupling 3D finite element model was created by using MIMICS10.0 and ANSYS14.5. The healthy (without stenosis) and the diseased (ratios of stenosis include 15%, 30%, 45%, 60%, 70%, 80%, and 90%) situations were simulated. A remote displacement of 60° was applied at a distal ICA (the right ICA was chosen here) to imitate the rotatory manipulation. Blood flow was then monitored at the anterior communicating artery (ACoA) and posterior communicating arteries (PCoA). Results Before the conduction of rotatory manipulation, blood flow changed significantly only when the stenosis ratio was increased to more than 70%, and the situation did not have significant difference after the application of remote displacement except the model with stenosis ration of 90%. Conclusions The result suggests that the rotatory manipulation does not have an obvious influence on the blood flow in the CoW when the stenosis of ICA is less than 90%, and this kind of manipulation is suggested to be a safe technique in most of the clinical applications.
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Affiliation(s)
- Weishen Lin
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, China (mainland)
| | - Xiaokang Ma
- PERA GLOBAL-Guangzhou Branch, Guangzhou, Guangdong, China (mainland)
| | - Datai Deng
- PERA GLOBAL-Guangzhou Branch, Guangzhou, Guangdong, China (mainland)
| | - Yikai Li
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, China (mainland)
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12
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Vrselja Z, Brkic H, Mrdenovic S, Radic R, Curic G. Function of circle of Willis. J Cereb Blood Flow Metab 2014; 34:578-84. [PMID: 24473483 PMCID: PMC3982101 DOI: 10.1038/jcbfm.2014.7] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 12/31/2013] [Accepted: 01/06/2014] [Indexed: 12/21/2022]
Abstract
Nearly 400 years ago, Thomas Willis described the arterial ring at the base of the brain (the circle of Willis, CW) and recognized it as a compensatory system in the case of arterial occlusion. This theory is still accepted. We present several arguments that via negativa should discard the compensatory theory. (1) Current theory is anthropocentric; it ignores other species and their analog structures. (2) Arterial pathologies are diseases of old age, appearing after gene propagation. (3) According to the current theory, evolution has foresight. (4) Its commonness among animals indicates that it is probably a convergent evolutionary structure. (5) It was observed that communicating arteries are too small for effective blood flow, and (6) missing or hypoplastic in the majority of the population. We infer that CW, under physiologic conditions, serves as a passive pressure dissipating system; without considerable blood flow, pressure is transferred from the high to low pressure end, the latter being another arterial component of CW. Pressure gradient exists because pulse wave and blood flow arrive into the skull through different cerebral arteries asynchronously, due to arterial tree asymmetry. Therefore, CW and its communicating arteries protect cerebral artery and blood-brain barrier from hemodynamic stress.
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Affiliation(s)
- Zvonimir Vrselja
- 1] Department of Anatomy and Neuroscience, Medical School of J. J. Strossmayer University in Osijek, Osijek, Croatia [2] Department of Radiology, Osijek University Medical Center, Osijek, Croatia
| | - Hrvoje Brkic
- Department of Biophysics, Medical Statistics and Medical Informatics, Medical School of J. J. Strossmayer University in Osijek, Osijek, Croatia
| | - Stefan Mrdenovic
- Department of Hematology, Osijek University Medical Center, Osijek, Croatia
| | - Radivoje Radic
- Department of Anatomy and Neuroscience, Medical School of J. J. Strossmayer University in Osijek, Osijek, Croatia
| | - Goran Curic
- 1] Department of Chemistry and Biochemistry, Laboratory for DNA Analysis, Medical School of J. J. Strossmayer University in Osijek, Osijek, Croatia [2] Department of Pathology and Legal Medicine, Osijek University Medical Center, Osijek, Croatia
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Liu LP, Xu AD, Wong LKS, Wang DZ, Wang YJ. Chinese consensus statement on the evaluation and intervention of collateral circulation for ischemic stroke. CNS Neurosci Ther 2014; 20:202-8. [PMID: 24495505 PMCID: PMC4233984 DOI: 10.1111/cns.12226] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 12/20/2013] [Accepted: 12/22/2013] [Indexed: 02/06/2023] Open
Abstract
Background Collateral circulation is becoming more significant in the individual management strategy of ischemic stroke, there are more data updated recently. Aim To make the further acknowledgment of the evaluation and how to improving collateral flow, for better treatment selection. Method A panel of experts on stroke providing related statement based on review the results from most up‐to‐date clinical research. Results DSA is the gold standard in evaluating all levels of collaterals. CTA can be used for evaluating leptomeningeal collaterals, MRA for CoW, TCD or TCCS can be used as screening tool for primary evaluation. The treatment modalities include direct interventions, such as Extracranial–Intracranial bypass, and indirect interventions, as External counterpulsation and pressor therapy. The consideration of methodology to augment and improve can be considered on an individual basis. Discussion In this consensus, we interpret the definition, neuroimaging evaluation, intervention and potential strategy on collaterals in the future. Conclusion Assessment of collateral circulation is crucial for selecting therapeutic options, predicting infarction volume and making prognosis after ischemic stroke. Data is still needed to provide therapeutic evidence for many new developed technologies. Until more evidence is available, the clinical significance of applying the new technologies is unclear and perhaps limited.
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Affiliation(s)
- Li-Ping Liu
- Departments of Neurology and Stroke Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Chuang YM, Huang KL, Chang YJ, Chang CH, Chang TY, Wu TC, Lin CP, Wong HF, Liu SJ, Lee TH. Associations between Circle of Willis Morphology and White Matter Lesion Load in Subjects with Carotid Artery Stenosis. Eur Neurol 2011; 66:136-44. [DOI: 10.1159/000329274] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Accepted: 05/02/2011] [Indexed: 11/19/2022]
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15
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Ursino M, Giannessi M. A Model of Cerebrovascular Reactivity Including the Circle of Willis and Cortical Anastomoses. Ann Biomed Eng 2010; 38:955-74. [DOI: 10.1007/s10439-010-9923-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Accepted: 01/07/2010] [Indexed: 01/26/2023]
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