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Yang K, Musio F, Ma Y, Juchler N, Paetzold JC, Al-Maskari R, Höher L, Li HB, Hamamci IE, Sekuboyina A, Shit S, Huang H, Prabhakar C, de la Rosa E, Waldmannstetter D, Kofler F, Navarro F, Menten M, Ezhov I, Rueckert D, Vos I, Ruigrok Y, Velthuis B, Kuijf H, Hämmerli J, Wurster C, Bijlenga P, Westphal L, Bisschop J, Colombo E, Baazaoui H, Makmur A, Hallinan J, Wiestler B, Kirschke JS, Wiest R, Montagnon E, Letourneau-Guillon L, Galdran A, Galati F, Falcetta D, Zuluaga MA, Lin C, Zhao H, Zhang Z, Ra S, Hwang J, Park H, Chen J, Wodzinski M, Müller H, Shi P, Liu W, Ma T, Yalçin C, Hamadache RE, Salvi J, Llado X, Lal-Trehan Estrada UM, Abramova V, Giancardo L, Oliver A, Liu J, Huang H, Cui Y, Lin Z, Liu Y, Zhu S, Patel TR, Tutino VM, Orouskhani M, Wang H, Mossa-Basha M, Zhu C, Rokuss MR, Kirchhoff Y, Disch N, Holzschuh J, Isensee F, Maier-Hein K, Sato Y, Hirsch S, Wegener S, Menze B. Benchmarking the CoW with the TopCoW Challenge: Topology-Aware Anatomical Segmentation of the Circle of Willis for CTA and MRA. ArXiv 2024:arXiv:2312.17670v3. [PMID: 38235066 PMCID: PMC10793481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
The Circle of Willis (CoW) is an important network of arteries connecting major circulations of the brain. Its vascular architecture is believed to affect the risk, severity, and clinical outcome of serious neuro-vascular diseases. However, characterizing the highly variable CoW anatomy is still a manual and time-consuming expert task. The CoW is usually imaged by two angiographic imaging modalities, magnetic resonance angiography (MRA) and computed tomography angiography (CTA), but there exist limited public datasets with annotations on CoW anatomy, especially for CTA. Therefore we organized the TopCoW Challenge in 2023 with the release of an annotated CoW dataset. The TopCoW dataset was the first public dataset with voxel-level annotations for thirteen possible CoW vessel components, enabled by virtual-reality (VR) technology. It was also the first large dataset with paired MRA and CTA from the same patients. TopCoW challenge formalized the CoW characterization problem as a multiclass anatomical segmentation task with an emphasis on topological metrics. We invited submissions worldwide for the CoW segmentation task, which attracted over 140 registered participants from four continents. The top performing teams managed to segment many CoW components to Dice scores around 90%, but with lower scores for communicating arteries and rare variants. There were also topological mistakes for predictions with high Dice scores. Additional topological analysis revealed further areas for improvement in detecting certain CoW components and matching CoW variant topology accurately. TopCoW represented a first attempt at benchmarking the CoW anatomical segmentation task for MRA and CTA, both morphologically and topologically.
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Affiliation(s)
- Kaiyuan Yang
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
| | - Fabio Musio
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
- Center for Computational Health, Zurich University of Applied Sciences, Zurich, Switzerland
| | - Yihui Ma
- Department of Neuroradiology, University Hospital of Zurich, Zurich, Switzerland
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Norman Juchler
- Center for Computational Health, Zurich University of Applied Sciences, Zurich, Switzerland
| | - Johannes C. Paetzold
- Department of Computing, Imperial College London, London, UK
- Institute for Tissue Engineering and Regenerative Medicine (iTERM), Helmholtz Center, Munich, Germany
| | - Rami Al-Maskari
- Institute for Tissue Engineering and Regenerative Medicine (iTERM), Helmholtz Center, Munich, Germany
| | - Luciano Höher
- Institute for Tissue Engineering and Regenerative Medicine (iTERM), Helmholtz Center, Munich, Germany
| | - Hongwei Bran Li
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
- Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, Boston, USA
| | | | - Anjany Sekuboyina
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
| | - Suprosanna Shit
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
- School of Medicine, Technical University of Munich, Munich, Germany
| | - Houjing Huang
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
| | - Chinmay Prabhakar
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
| | - Ezequiel de la Rosa
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
| | - Diana Waldmannstetter
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
- Department of Informatics, Technical University of Munich, Munich, Germany
| | - Florian Kofler
- School of Medicine, Technical University of Munich, Munich, Germany
- Department of Informatics, Technical University of Munich, Munich, Germany
- Helmholtz AI, Helmholtz Munich, Munich, Germany
| | - Fernando Navarro
- School of Medicine, Technical University of Munich, Munich, Germany
- Department of Informatics, Technical University of Munich, Munich, Germany
| | - Martin Menten
- Department of Computing, Imperial College London, London, UK
- Department of Informatics, Technical University of Munich, Munich, Germany
| | - Ivan Ezhov
- Department of Informatics, Technical University of Munich, Munich, Germany
| | - Daniel Rueckert
- Department of Computing, Imperial College London, London, UK
- Department of Informatics, Technical University of Munich, Munich, Germany
| | - Iris Vos
- Image Sciences Institute, UMC Utrecht, Utrecht, the Netherlands
| | - Ynte Ruigrok
- Department of Neurology, UMC Utrecht, Utrecht, the Netherlands
| | | | - Hugo Kuijf
- Image Sciences Institute, UMC Utrecht, Utrecht, the Netherlands
| | - Julien Hämmerli
- Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
| | - Catherine Wurster
- Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
| | - Philippe Bijlenga
- Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
| | - Laura Westphal
- Department of Neurology, University Hospital of Zurich, Zurich, Switzerland
| | - Jeroen Bisschop
- Department of Physiology, University of Toronto, Toronto, Canada
| | - Elisa Colombo
- Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland
| | - Hakim Baazaoui
- Department of Neurology, University Hospital of Zurich, Zurich, Switzerland
| | - Andrew Makmur
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - James Hallinan
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Bene Wiestler
- School of Medicine, Technical University of Munich, Munich, Germany
| | - Jan S. Kirschke
- School of Medicine, Technical University of Munich, Munich, Germany
| | - Roland Wiest
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Berne and University of Berne, Berne, Switzerland
| | - Emmanuel Montagnon
- Centre de Recherche du Centre Hospitalier de l’Université de Montreal (CRCHUM), Montreal, Canada
| | | | | | | | | | | | - Chaolong Lin
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China
| | - Haoran Zhao
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China
| | - Zehan Zhang
- Hangzhou Genlight Medtech Co. Ltd., Hangzhou, China
| | - Sinyoung Ra
- Department of Artificial Intelligence, Sungkyunkwan University, Seoul, Korea
| | - Jongyun Hwang
- Department of Artificial Intelligence, Sungkyunkwan University, Seoul, Korea
| | - Hyunjin Park
- Department of Electrical and Computer Engineering, Sungkyunkwan University, Seoul, Korea
| | - Junqiang Chen
- Shanghai MediWorks Precision Instruments Co.,Ltd, Shanghai, China
| | - Marek Wodzinski
- Institute of Informatics, HES-SO Valais-Wallis, Switzerland
- Department of Measurement and Electronics, AGH University of Krakow, Poland
| | - Henning Müller
- Institute of Informatics, HES-SO Valais-Wallis, Switzerland
| | - Pengcheng Shi
- Electronic & Information Engineering School, Harbin Institute of Technology (Shenzhen), Shenzhen, China
| | - Wei Liu
- Electronic & Information Engineering School, Harbin Institute of Technology (Shenzhen), Shenzhen, China
| | - Ting Ma
- Electronic & Information Engineering School, Harbin Institute of Technology (Shenzhen), Shenzhen, China
- Peng Cheng Laboratory, Shenzhen, China
| | - Cansu Yalçin
- Research Institute of Computer Vision and Robotics (ViCOROB), Universitat de Girona, Catalonia, Spain
| | - Rachika E. Hamadache
- Research Institute of Computer Vision and Robotics (ViCOROB), Universitat de Girona, Catalonia, Spain
| | - Joaquim Salvi
- Research Institute of Computer Vision and Robotics (ViCOROB), Universitat de Girona, Catalonia, Spain
| | - Xavier Llado
- Research Institute of Computer Vision and Robotics (ViCOROB), Universitat de Girona, Catalonia, Spain
| | | | - Valeriia Abramova
- Research Institute of Computer Vision and Robotics (ViCOROB), Universitat de Girona, Catalonia, Spain
| | - Luca Giancardo
- Center for Precision Health, McWilliams School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, USA
| | - Arnau Oliver
- Research Institute of Computer Vision and Robotics (ViCOROB), Universitat de Girona, Catalonia, Spain
| | - Jialu Liu
- Laboratory of Brain Atlas and Brain-inspired Intelligence, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Haibin Huang
- Laboratory of Brain Atlas and Brain-inspired Intelligence, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Yue Cui
- Laboratory of Brain Atlas and Brain-inspired Intelligence, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Zehang Lin
- School of Computer and Information Engineering, Xiamen University of Technology, Xiamen, China
| | - Yusheng Liu
- Department of Automation, Shanghai Jiao Tong University, Shanghai, China
| | - Shunzhi Zhu
- School of Computer and Information Engineering, Xiamen University of Technology, Xiamen, China
| | - Tatsat R. Patel
- Canon Stroke and Vascular Research Center, Buffalo, USA
- Department of Pathology and Anatomical Sciences, University at Buffalo, Buffalo, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, USA
| | - Vincent M. Tutino
- Canon Stroke and Vascular Research Center, Buffalo, USA
- Department of Pathology and Anatomical Sciences, University at Buffalo, Buffalo, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, USA
- Department of Biomedical Engineering, University at Buffalo, Buffalo, USA
| | | | - Huayu Wang
- Department of Radiology, University of Washington, Seattle, USA
| | | | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, USA
| | - Maximilian R. Rokuss
- German Cancer Research Center (DKFZ) Heidelberg, Division of Medical Image Computing, Germany
- Faculty of Mathematics and Computer Science, Heidelberg University, Germany
| | - Yannick Kirchhoff
- German Cancer Research Center (DKFZ) Heidelberg, Division of Medical Image Computing, Germany
- Faculty of Mathematics and Computer Science, Heidelberg University, Germany
- HIDSS4Health - Helmholtz Information and Data Science School for Health, Karlsruhe/Heidelberg, Germany
| | - Nico Disch
- German Cancer Research Center (DKFZ) Heidelberg, Division of Medical Image Computing, Germany
- Faculty of Mathematics and Computer Science, Heidelberg University, Germany
- HIDSS4Health - Helmholtz Information and Data Science School for Health, Karlsruhe/Heidelberg, Germany
| | - Julius Holzschuh
- German Cancer Research Center (DKFZ) Heidelberg, Division of Medical Image Computing, Germany
| | - Fabian Isensee
- German Cancer Research Center (DKFZ) Heidelberg, Division of Medical Image Computing, Germany
- Helmholtz Imaging, German Cancer Research Center, Heidelberg, Germany
| | - Klaus Maier-Hein
- German Cancer Research Center (DKFZ) Heidelberg, Division of Medical Image Computing, Germany
- Pattern Analysis and Learning Group, Department of Radiation Oncology, Heidelberg University Hospital
| | | | - Sven Hirsch
- Center for Computational Health, Zurich University of Applied Sciences, Zurich, Switzerland
| | - Susanne Wegener
- Department of Neurology, University Hospital of Zurich, Zurich, Switzerland
| | - Bjoern Menze
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
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Myrcha P, Pinheiro F, Rocha-Neves J, Myrcha J, Gloviczki P. The effect of the collateral cerebrovascular circulation on tolerance to carotid artery cross-clamping and on early outcome after carotid endarterectomy. J Vasc Surg 2024:S0741-5214(24)01078-4. [PMID: 38679219 DOI: 10.1016/j.jvs.2024.04.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/14/2024] [Accepted: 04/20/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND The Circle of Willis (CoW) serves as the primary source of contralateral blood supply in patients who undergo carotid artery cross-clamping (CC) for carotid endarterectomy (CEA). It has been suggested that CoW's anatomy influences CEA outcomes. The aim of this study was to evaluate associations between the cerebral collateral circulation, a positive awake test for intraoperative neurologic deficit after carotid CC and postoperative adverse neurologic events. METHODS A systematic review was conducted searching MEDLINE, Cochrane and Web of Science databases for studies that assessed the cerebral circulation, including CoW variations, using neuroimaging techniques in patients who underwent carotid CC. For the metanalytical incidence, the statistical technique used was weight averaging. Otherwise, descriptive analysis was used due to the excessive heterogeneity of the studies. RESULTS Eight publications, seven cohort and one case-controlled study, involving 1313 patients who underwent carotid artery cross-clamping under LRA were included in the systematic review. The incidence of positive awake test in the cohort studies ranged from 4.4% to 19.7%. Carotid artery cross-clamping (CC) resulted in positive awake test in 5% to 91% of patients with alterations in the anterior portion and in 27% to 74% with alterations in the posterior portion of the Circle of Willis. A positive awake test in patients with contralateral carotid stenosis or occlusion ranged from 5.8% to 45.7%. Contralateral carotid stenosis >70% or occlusion were associated with a positive awake test (P <.001). Patients with incomplete CoW did not have statistically significant correlation with intraoperative neurological deficits after CC. Data were insufficient to evaluate the effect of the collateral circulation on early outcome after CEA. CONCLUSION In this systematic review, contralateral carotid artery stenosis or occlusion but not CoW abnormalities were associated with a positive awake test after carotid artery CC. Further research is needed to evaluate which specific CoW anomaly predicts neurologic deficit after CC and to confirm association between a positive awake test and clinical outcome after CEA.
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Affiliation(s)
- Piotr Myrcha
- Department of General and Vascular Surgery, Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland; Department of General, Vascular and Oncological Surgery, Masovian Brodnowski Hospital, 03-242 Warsaw, Poland.
| | | | - João Rocha-Neves
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal; Department of Biomedicine- Unit of Anatomy, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal.
| | - Jakub Myrcha
- Department of Vascular Surgery and Angiology, Bielanski Hospital, 01-809 Warsaw, Poland.
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Lengyel B, Magyar-Stang R, Pál H, Debreczeni R, Sándor ÁD, Székely A, Gyürki D, Csippa B, István L, Kovács I, Sótonyi P, Mihály Z. Non-Invasive Tools in Perioperative Stroke Risk Assessment for Asymptomatic Carotid Artery Stenosis with a Focus on the Circle of Willis. J Clin Med 2024; 13:2487. [PMID: 38731014 DOI: 10.3390/jcm13092487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/17/2024] [Accepted: 04/20/2024] [Indexed: 05/13/2024] Open
Abstract
This review aims to explore advancements in perioperative ischemic stroke risk estimation for asymptomatic patients with significant carotid artery stenosis, focusing on Circle of Willis (CoW) morphology based on the CTA or MR diagnostic imaging in the current preoperative diagnostic algorithm. Functional transcranial Doppler (fTCD), near-infrared spectroscopy (NIRS), and optical coherence tomography angiography (OCTA) are discussed in the context of evaluating cerebrovascular reserve capacity and collateral vascular systems, particularly the CoW. These non-invasive diagnostic tools provide additional valuable insights into the cerebral perfusion status. They support biomedical modeling as the gold standard for the prediction of the potential impact of carotid artery stenosis on the hemodynamic changes of cerebral perfusion. Intraoperative risk assessment strategies, including selective shunting, are explored with a focus on CoW variations and their implications for perioperative ischemic stroke and cognitive function decline. By synthesizing these insights, this review underscores the potential of non-invasive diagnostic methods to support clinical decision making and improve asymptomatic patient outcomes by reducing the risk of perioperative ischemic neurological events and preventing further cognitive decline.
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Affiliation(s)
- Balázs Lengyel
- Department of Vascular and Endovascular Surgery, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary
| | - Rita Magyar-Stang
- Department of Neurology, Semmelweis University, 1085 Budapest, Hungary
- Szentágothai Doctoral School of Neurosciences, Semmelweis University, 1085 Budapest, Hungary
| | - Hanga Pál
- Department of Neurology, Semmelweis University, 1085 Budapest, Hungary
- Szentágothai Doctoral School of Neurosciences, Semmelweis University, 1085 Budapest, Hungary
| | - Róbert Debreczeni
- Department of Neurology, Semmelweis University, 1085 Budapest, Hungary
- Szentágothai Doctoral School of Neurosciences, Semmelweis University, 1085 Budapest, Hungary
| | - Ágnes Dóra Sándor
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1085 Budapest, Hungary
| | - Andrea Székely
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1085 Budapest, Hungary
| | - Dániel Gyürki
- Department of Hydrodynamic Systems, Faculty of Mechanical Engineering, Budapest University of Technology and Economics, 1085 Budapest, Hungary
| | - Benjamin Csippa
- Department of Hydrodynamic Systems, Faculty of Mechanical Engineering, Budapest University of Technology and Economics, 1085 Budapest, Hungary
| | - Lilla István
- Department of Ophthalmology, Semmelweis University, 1085 Budapest, Hungary
| | - Illés Kovács
- Department of Ophthalmology, Semmelweis University, 1085 Budapest, Hungary
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY 10065, USA
- Department of Clinical Ophthalmology, Faculty of Health Sciences, Semmelweis University, 1085 Budapest, Hungary
| | - Péter Sótonyi
- Department of Vascular and Endovascular Surgery, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary
| | - Zsuzsanna Mihály
- Department of Vascular and Endovascular Surgery, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary
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Coccarelli A, Van Loon R, Chien A. A Computational Pipeline to Investigate Longitudinal Blood Flow Changes in the Circle of Willis of Patients with Stable and Growing Aneurysms. Ann Biomed Eng 2024:10.1007/s10439-024-03493-1. [PMID: 38616236 DOI: 10.1007/s10439-024-03493-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/10/2024] [Indexed: 04/16/2024]
Abstract
Changes in cerebral blood flow are often associated with the initiation and development of different life-threatening medical conditions including aneurysm rupture and ischemic stroke. Nevertheless, it is not fully clear how haemodynamic changes in time across the Circle of Willis (CoW) are related with intracranial aneurysm (IA) growth. In this work, we introduced a novel reduced-order modelling strategy for the systematic quantification of longitudinal blood flow changes across the whole CoW in patients with stable and unstable/growing aneurysm. Magnetic Resonance Angiography (MRA) images were converted into one-dimensional (1-D) vessel networks through a semi-automated procedure, with a level of geometric reconstruction accuracy controlled by user-dependent parameters. The proposed pipeline was used to systematically analyse longitudinal haemodynamic changes in seven different clinical cases. Our preliminary simulation results indicate that growing aneurysms are not necessarily associated with significant changes in mean flow over time. A concise sensitivity analysis also shed light on which modelling aspects need to be further characterized to have reliable patient-specific predictions. This study poses the basis for investigating how time-dependent changes in the vasculature affect the haemodynamics across the whole CoW in patients with stable and growing aneurysms.
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Affiliation(s)
- Alberto Coccarelli
- Zienkiewicz Institute for Modelling, Data and AI, Faculty of Science and Engineering, Swansea University, Swansea, UK.
- Department of Mechanical Engineering, Faculty of Science and Engineering, Swansea University, Swansea, UK.
| | - Raoul Van Loon
- Zienkiewicz Institute for Modelling, Data and AI, Faculty of Science and Engineering, Swansea University, Swansea, UK
- Biomedical Engineering Simulation and Testing Lab, Department of Biomedical Engineering, Faculty of Science and Engineering, Swansea University, Swansea, UK
| | - Aichi Chien
- Radiological Sciences, School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
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Yang H, Cho KC, Hong I, Kim Y, Kim YB, Kim JJ, Oh JH. Influence of circle of Willis modeling on hemodynamic parameters in anterior communicating artery aneurysms and recommendations for model selection. Sci Rep 2024; 14:8476. [PMID: 38605063 PMCID: PMC11009257 DOI: 10.1038/s41598-024-59042-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/04/2024] [Indexed: 04/13/2024] Open
Abstract
Computational fluid dynamics (CFD) has been utilized to calculate hemodynamic parameters in anterior communicating artery aneurysm (AComA), which is located at a junction between left and right A1 and A2 segments. However, complete or half circle of Willis (CoW) models are used indiscriminately. This study aims to suggest recommendations for determining suitable CoW model. Five patient-specific CoW models with AComA were used, and each model was divided into complete, left-half, and right-half models. After validating the CFD using a flow experiment, the hemodynamic parameters and flow patterns in five AComAs were compared. In four out of five cases, inflow from one A1 side had a dominant influence on the AComA, while both left and right A1 sides affected the AComA in the remaining case. Also, the average difference in time-averaged wall shear stress between the complete and half models for four cases was 4.6%, but it was 62% in the other case. The differences in the vascular resistances of left and right A1 and A2 segments greatly influenced the flow patterns in the AComA. These results may help to enhance clinicians' understanding of blood flow in the brain, leading to improvements in diagnosis and treatment of cerebral aneurysms.
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Affiliation(s)
- Hyeondong Yang
- Department of Mechanical Engineering and BK21 FOUR ERICA-ACE Center, Hanyang University, 55 Hanyangdaehak-Ro, Sangnok-Gu, Ansan, 15588, Gyeonggi-Do, Korea
| | - Kwang-Chun Cho
- Department of Neurosurgery, College of Medicine, Yonsei University, Yongin Severance Hospital, Yongin, Gyeonggi-Do, Korea
| | - Ineui Hong
- Department of Mechanical Engineering and BK21 FOUR ERICA-ACE Center, Hanyang University, 55 Hanyangdaehak-Ro, Sangnok-Gu, Ansan, 15588, Gyeonggi-Do, Korea
| | - Yeonwoo Kim
- Department of Mechanical Engineering and BK21 FOUR ERICA-ACE Center, Hanyang University, 55 Hanyangdaehak-Ro, Sangnok-Gu, Ansan, 15588, Gyeonggi-Do, Korea
| | - Yong Bae Kim
- Department of Neurosurgery, College of Medicine, Yonsei University, Severance Hospital, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Korea
| | - Jung-Jae Kim
- Department of Neurosurgery, College of Medicine, Yonsei University, Severance Hospital, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Korea.
- Department of Anatomy, Graduate School of Medicine, Korea University, 13 Jongam-Ro, Seongbuk-Gu, Seoul, 02841, Korea.
| | - Je Hoon Oh
- Department of Mechanical Engineering and BK21 FOUR ERICA-ACE Center, Hanyang University, 55 Hanyangdaehak-Ro, Sangnok-Gu, Ansan, 15588, Gyeonggi-Do, Korea.
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Voss HU, Razlighi QR. Pulsatility analysis of the circle of Willis. Aging Brain 2024; 5:100111. [PMID: 38495808 PMCID: PMC10940807 DOI: 10.1016/j.nbas.2024.100111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 02/13/2024] [Accepted: 02/26/2024] [Indexed: 03/19/2024] Open
Abstract
Purpose To evaluate the phenomenological significance of cerebral blood pulsatility imaging in aging research. Methods N = 38 subjects from 20 to 72 years of age (24 females) were imaged with ultrafast MRI with a sampling rate of 100 ms and simultaneous acquisition of pulse oximetry data. Of these, 28 subjects had acceptable MRI and pulse data, with 16 subjects between 20 and 28 years of age, and 12 subjects between 61 and 72 years of age. Pulse amplitude in the circle of Willis was assessed with the recently developed method of analytic phase projection to extract blood volume waveforms. Results Arteries in the circle of Willis showed pulsatility in the MRI for both the young and old age groups. Pulse amplitude in the circle of Willis significantly increased with age (p = 0.01) but was independent of gender, heart rate, and head motion during MRI. Discussion and conclusion Increased pulse wave amplitude in the circle of Willis in the elderly suggests a phenomenological significance of cerebral blood pulsatility imaging in aging research. The physiologic origin of increased pulse amplitude (increased pulse pressure vs. change in arterial morphology vs. re-shaping of pulse waveforms caused by the heart, and possible interaction with cerebrospinal fluid pulsatility) requires further investigation.
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Affiliation(s)
- Henning U. Voss
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
- Cornell MRI Facility, College of Human Ecology, Cornell University, Ithaca, NY, USA
| | - Qolamreza R. Razlighi
- Quantitative Neuroimaging Laboratory, Brain Health Imaging Institute, Department of Radiology, Weill Cornell Medicine, New York, NY, USA
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Ophelders MEH, van Eldik MJA, Vos IN, Beentjes YS, Velthuis BK, Ruigrok YM. Anatomical differences of intracranial arteries according to sex: a systematic review and meta-analysis. J Neuroradiol 2024; 51:10-15. [PMID: 37209774 DOI: 10.1016/j.neurad.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/12/2023] [Accepted: 05/12/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND AND PURPOSE Intracranial aneurysms are more common in women than in men. Some anatomical variants of the circle of Willis (CoW) are associated with a higher risk of developing intracranial aneurysms. We hypothesized that variations of the CoW are sex dependent which may partly explain why intracranial aneurysms are more common in women. We systematically reviewed and meta-analyzed the literature to compare the presence of anatomical variations of the CoW between women and men in the general population. MATERIAL AND METHODS A systematic search in Pubmed and EMBASE using predefined criteria, following the PRISMA guidelines was performed. The presence of different CoW anatomical variants and a complete CoW was compared between women and men using an inverse variance weighted random effects meta-analysis to calculate relative risks (RR) with 95% confidence intervals (95% CIs). RESULTS Fourteen studies were included reporting on 5478 healthy participants (2511 women, 2967 men). Bilateral fetal type posterior cerebral arteries (RR 2.79; 95%CI 1.65-4.72, I2=0%), and a complete CoW (RR 1.24, 95%CI 1.13-1.36; I2=0%) were more prevalent in women than in men. The variants absence or hypoplasia of one of the anterior cerebral arteries (RR 0.58, 95%CI 0.38-0.88, I2=57%) and hypoplasia or absence of both posterior communicating arteries (RR 0.79, 95%CI 0.71-0.87, I2=0%) were more prevalent in men. CONCLUSIONS Several anatomical variations of the CoW are sex dependent, with some variants being more common in women while others in men. Future research should assess how these sex-specific CoW variants relate to the sex-specific occurrence of intracranial aneurysms.
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Affiliation(s)
- M E H Ophelders
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - M J A van Eldik
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - I N Vos
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Y S Beentjes
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - B K Velthuis
- Department of Radiology, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Y M Ruigrok
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht University, The Netherlands.
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Gaidzik F, Korte J, Saalfeld S, Janiga G, Berg P. Image-based hemodynamic simulations for intracranial aneurysms: the impact of complex vasculature. Int J Comput Assist Radiol Surg 2024:10.1007/s11548-023-03045-3. [PMID: 38206468 DOI: 10.1007/s11548-023-03045-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/06/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE Hemodynamics play an important role in the assessment of intracranial aneurysm (IA) development and rupture risk. The purpose of this study was to examine the impact of complex vasculatures onto the intra-vessel and intra-aneurysmal blood flow. METHODS Complex segmentation of a subject-specific, 60-outlet and 3-inlet circle of Willis model captured with 7T magnetic resonance imaging was performed. This model was trimmed to a 10-outlet model version. Two patient-specific IAs were added onto both models yielding two pathological versions, and image-based blood flow simulations of the four resulting cases were carried out. To capture the differences between complex and trimmed model, time-averaged and centerline velocities were compared. The assessment of intra-saccular blood flow within the IAs involved the evaluation of wall shear stresses (WSS) at the IA wall and neck inflow rates (NIR). RESULTS Lower flow values are observed in the majority of the complex model. However, at specific locations (left middle cerebral artery 0.5 m/s, left posterior cerebral artery 0.25 m/s), higher flow rates were visible when compared to the trimmed counterpart. Furthermore, at the centerlines the total velocity values reveal differences up to 0.15 m/s. In the IAs, the reduction in the neck inflow rate and WSS in the complex model was observed for the first IA (IA-A δNIRmean = - 0.07ml/s, PCA.l δWSSmean = - 0.05 Pa). The second IA featured an increase in the neck inflow rate and WSS (IA-B δNIRmean = 0.04 ml/s, PCA.l δWSSmean = 0.07 Pa). CONCLUSION Both the magnitude and shape of the flow distribution vary depending on the model's complexity. The magnitude is primarily influenced by the global vessel model, while the shape is determined by the local structure. Furthermore, intra-aneurysmal flow strongly depends on the location in the vessel tree, emphasizing the need for complex model geometries for realistic hemodynamic assessment and rupture risk analysis.
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Affiliation(s)
- Franziska Gaidzik
- Research Campus STIMULATE, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany.
- Laboratory of Fluid Dynamics and Technical Flows, Forschungscampus STIMULATE, Otto-von-Guericke-University Magdeburg, Universitätsplatz 2, 39106, Magdeburg, Germany.
| | - Jana Korte
- Research Campus STIMULATE, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
- Laboratory of Fluid Dynamics and Technical Flows, Forschungscampus STIMULATE, Otto-von-Guericke-University Magdeburg, Universitätsplatz 2, 39106, Magdeburg, Germany
| | - Sylvia Saalfeld
- Research Campus STIMULATE, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
- Laboratory of Simulation and Graphics, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Gábor Janiga
- Research Campus STIMULATE, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
- Laboratory of Fluid Dynamics and Technical Flows, Forschungscampus STIMULATE, Otto-von-Guericke-University Magdeburg, Universitätsplatz 2, 39106, Magdeburg, Germany
| | - Philipp Berg
- Research Campus STIMULATE, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
- Department of Medical Engineering, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
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Zarrinkoob L, Myrnäs S, Wåhlin A, Eklund A, Malm J. Cerebral Blood Flow Patterns in Patients With Low-Flow Carotid Artery Stenosis, a 4D-PCMRI Assessment. J Magn Reson Imaging 2024. [PMID: 38168876 DOI: 10.1002/jmri.29216] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Compromised cerebral blood flow can contribute to future ischemic events in patients with symptomatic carotid artery disease. However, there is limited knowledge of the effects on cerebral hemodynamics resulting from a reduced internal carotid artery (ICA) blood flow rate (BFR). PURPOSE Investigate how reduced ICA-BFR, relates to BFR in the cerebral arteries. STUDY TYPE Prospective. SUBJECTS Thirty-eight patients, age 72 ± 6 years (11 female). FIELD STRENGTH/SEQUENCE 3-Tesla, four-dimensional phase-contrast magnetic resonance imaging (4D-PCMRI). ASSESSMENT Patients with ischemic stroke or transient ischemic attack were evaluated regarding the degree of stenosis. 4D-PCMRI was used to measure cerebral BFR in 38 patients with symptomatic carotid stenosis (≥50%). BFR in the cerebral arteries was assessed in two subgroups based on symptomatic ICA-BFR: reduced ICA-flow (<160 mL/minutes) and preserved ICA-flow (≥160 mL/minutes). BFR laterality was defined as a difference in the paired ipsilateral-contralateral arteries. STATISTICAL TESTS Patients were grouped based on ICA-BFR (reduced vs. preserved). Statistical tests (independent sample t-test/paired t-test) were used to compare groups and hemispheres. Significance was determined at P < 0.05. RESULTS The degree of stenosis was not significantly different, 80% (95% confidence interval [CI] = 73%-87%) in the reduced ICA-flow vs. 72% (CI = 66%-76%) in the preserved ICA-flow; P = 0.09. In the reduced ICA-flow group, a significantly reduced BFR was found in the ipsilateral middle cerebral artery and anterior cerebral artery (A1), while significantly increased in the contralateral A1. Retrograde BFR was found in the posterior communicating artery and ophthalmic artery. Significant BFR laterality was present in all paired arteries in the reduced ICA-flow group, contrasting the preserved ICA-flow group (P = 0.14-0.93). DATA CONCLUSIONS 4D-PCMRI revealed compromised cerebral BFR due to carotid stenosis, not possible to detect by solely analyzing the degree of stenosis. In patients with reduced ICA-flow, collaterals were not sufficient to maintain symmetrical BFR distribution to the two hemispheres. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Laleh Zarrinkoob
- Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care Medicine Unit, Umeå University, Umeå, Sweden
| | - Sanne Myrnäs
- Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care Medicine Unit, Umeå University, Umeå, Sweden
| | - Anders Wåhlin
- Department of Radiation Sciences, Biomedical Engineering, Umeå University, Umeå, Sweden
- Centre for Biomedical Engineering and Physics, Umeå University, Umeå, Sweden
- Umeå Center for Functional Brain Imaging, Umeå University, Umeå, Sweden
| | - Anders Eklund
- Centre for Biomedical Engineering and Physics, Umeå University, Umeå, Sweden
- Umeå Center for Functional Brain Imaging, Umeå University, Umeå, Sweden
| | - Jan Malm
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
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Patnaik O, Shahane P, Chandrupatla M, Raviteja P. Azygos anterior cerebral artery associated with hypoplastic A1 fragment of right anterior cerebral artery. Anat Cell Biol 2023:acb.23.177. [PMID: 37821394 DOI: 10.5115/acb.23.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/11/2023] [Accepted: 08/21/2023] [Indexed: 10/13/2023] Open
Abstract
Anterior cerebral arteries are paired and supply the major portion of the medial surface of the brain. They are branches of the intracranial part of the internal carotid artery and form the anterior portion of the circle of Willis (CW) which is situated in the interpeduncular fossa. During routine dissection in the department of anatomy, All India Institute of Medical Sciences, Bibinagar, Hyderabad, a rare variation had been observed in the CW, azygos anterior cerebral artery associated with hypoplastic A1 fragment of the right anterior cerebral artery in a 63-year-old female cadaver. It is important to identify and study this kind of rare variation for surgeons, anatomists, and radiologists during dissection, surgical, radiological, and diagnostic interventions.
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Affiliation(s)
- Omkar Patnaik
- Department of Anatomy, All India Institute of Medical Sciences, Bibinagar, India
| | - Preeti Shahane
- Department of Anatomy, All India Institute of Medical Sciences, Bibinagar, India
| | - Mrudula Chandrupatla
- Department of Anatomy, All India Institute of Medical Sciences, Bibinagar, India
| | - Punnapa Raviteja
- Department of Anatomy, All India Institute of Medical Sciences, Bibinagar, India
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11
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Rusu MC. Fenestration of posterior cerebral artery at the junction of P1 and P2 segments. Surg Radiol Anat 2023; 45:1269-1271. [PMID: 37524860 DOI: 10.1007/s00276-023-03221-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/24/2023] [Indexed: 08/02/2023]
Abstract
PURPOSE Fenestrations of posterior cerebral artery are exceedingly rare and, therefore, deserve being reported. METHODS During an educational dissection, a peculiar anatomical variant of the posterior cerebral artery (PCA) was found. RESULTS During an educational dissection targeting the right cerebellopontine angle, a peculiar variant of the right PCA was found. The respective posterior communicating artery inserted posteriorly into the junction of the P1 and P2 segments of the PCA. The P1 segment was thinner than the P2 segment. That junction was superior to the oculomotor nerve and was fenestrated, with a thin postero-medial arm facing the cerebral peduncle, and a larger antero-lateral arm formed by the distal end of the P1 segment and the proximal end of the P2 segment. CONCLUSIONS To the authors' knowledge, fenestrated P1-P2 junctions of PCA were not found previously by dissection. The evidence presented here recommends such variations not to be ignored.
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Affiliation(s)
- Mugurel Constantin Rusu
- Division of Anatomy, Faculty of Dentistry, "Carol Davila" University of Medicine and Pharmacy, 8 Eroilor Sanitari Blvd., 050474, Bucharest, Romania.
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12
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Nader R, Bourcier R, Autrusseau F. Using deep learning for an automatic detection and classification of the vascular bifurcations along the Circle of Willis. Med Image Anal 2023; 89:102919. [PMID: 37619447 DOI: 10.1016/j.media.2023.102919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/01/2023] [Accepted: 07/31/2023] [Indexed: 08/26/2023]
Abstract
Most of the intracranial aneurysms (ICA) occur on a specific portion of the cerebral vascular tree named the Circle of Willis (CoW). More particularly, they mainly arise onto fifteen of the major arterial bifurcations constituting this circular structure. Hence, for an efficient and timely diagnosis it is critical to develop some methods being able to accurately recognize each Bifurcation of Interest (BoI). Indeed, an automatic extraction of the bifurcations presenting the higher risk of developing an ICA would offer the neuroradiologists a quick glance at the most alarming areas. Due to the recent efforts on Artificial Intelligence, Deep Learning turned out to be the best performing technology for many pattern recognition tasks. Moreover, various methods have been particularly designed for medical image analysis purposes. This study intends to assist the neuroradiologists to promptly locate any bifurcation presenting a high risk of ICA occurrence. It can be seen as a Computer Aided Diagnosis scheme, where the Artificial Intelligence facilitates the access to the regions of interest within the MRI. In this work, we propose a method for a fully automatic detection and recognition of the bifurcations of interest forming the Circle of Willis. Several neural networks architectures have been tested, and we thoroughly evaluate the bifurcation recognition rate.
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Affiliation(s)
- Rafic Nader
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, France
| | - Romain Bourcier
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, France
| | - Florent Autrusseau
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, France; Nantes Université, Polytech'Nantes, LTeN, U-6607, Rue Ch. Pauc, 44306, Nantes, France.
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13
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Hindenes LB, Ingebrigtsen T, Isaksen JG, Håberg AK, Johnsen LH, Herder M, Mathiesen EB, Vangberg TR. Anatomical variations in the circle of Willis are associated with increased odds of intracranial aneurysms: The Tromsø study. J Neurol Sci 2023; 452:120740. [PMID: 37517271 DOI: 10.1016/j.jns.2023.120740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/06/2023] [Accepted: 07/23/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE Studies on patients suggest an association between anatomical variations in the Circle of Willis (CoW) and intracranial aneurysms (IA), but it is unclear whether this association is present in the general population. In this cross-sectional population study, we investigated the associations between CoW anatomical variations and IA. METHODS We included 1667 participants from a population sample with 3 T MRI time-of-flight angiography (40-84 years, 46.5% men). Saccular IAs were defined as protrusions in the intracranial arteries ≥2 mm, while variants of the CoW were classified according to whether segments were missing or hypoplastic (< 1 mm). We used logistic regression, adjusting for age and IA risk factors, to assess whether participants with incomplete CoW variants had a greater prevalence of IA and whether participants with specific incomplete variants had a greater prevalence of IA. RESULTS Participants with an incomplete CoW had an increased prevalence of IA (OR, 2.3 [95% CI 1.05-5.04]). This was mainly driven by the variant missing all three communicating arteries (OR, 4.2 [95% CI 1.7-1 0.3]) and the variant missing the P1 segment of the posterior cerebral artery (OR, 3.6 [95% CI 1.2-10.1]). The combined prevalence of the two variants was 15.4% but accounted for 28% of the IAs. CONCLUSION The findings suggest that an incomplete CoW is associated with an increased risk of IA for adults in the general population.
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Affiliation(s)
- Lars B Hindenes
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; PET Imaging Center, University Hospital of North Norway, Tromsø, Norway
| | - Tor Ingebrigtsen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Department of Neurosurgery, Ophthalmology, and Otorhinolaryngology, University Hospital of North Norway, Tromsø, Norway
| | - Jørgen G Isaksen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Department of Neurosurgery, Ophthalmology, and Otorhinolaryngology, University Hospital of North Norway, Tromsø, Norway
| | - Asta K Håberg
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Radiology and Nuclear Medicine, St. Olav University Hospital, Trondheim, Norway
| | - Liv-Hege Johnsen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - Marit Herder
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - Ellisiv B Mathiesen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Department of Neurology, University Hospital of North Norway, Tromsø, Norway
| | - Torgil R Vangberg
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; PET Imaging Center, University Hospital of North Norway, Tromsø, Norway.
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Del Brutto OH, Rumbea DA, Mera RM. Incompleteness of the Circle of Willis and progression of white matter hyperintensities of presumed vascular origin. A longitudinal prospective study in community-dwelling older adults. J Stroke Cerebrovasc Dis 2023; 32:107298. [PMID: 37562179 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Evidence on the association between anatomical variants of the circle of Willis (CoW) and severity of white matter hyperintensities (WMH) of presumed vascular origin is inconclusive, and no study has evaluated the role of incompleteness of CoW on WMH progression in the follow-up. This study aims to assess the impact of incomplete configurations of the CoW on WMH progression in community-dwelling older adults. METHODS Following a prospective longitudinal study design, individuals aged ≥60 years enrolled in the Atahualpa Project Cohort from 2012 to 2019 were invited to receive baseline brain MRI and MRA of intracranial vessels, and those who also had brain MRIs at the end of the study (May 2021) were included in the analysis. Poisson regression models, adjusted for demographics and cardiovascular risk factors, were fitted to assess the incidence rate ratio (IRR) of WMH progression according to incompleteness of CoW. RESULTS This study included 254 individuals (mean age: 65.4±5.9 years; 55% women). An incomplete CoW was detected in 99 (39%) subjects. Follow-up MRIs showed WMH progression in 103 (41%) individuals after a median follow-up of 6.5±1.4 years. WMH progression was observed in 58/155 subjects with complete and in 45/99 with incomplete CoW (37% versus 45%; p=0.203). There was no association between incomplete CoW and WMH progression in a multivariate Poisson regression model (IRR: 1.21; 95% C.I.: 0.81 - 1.82). CONCLUSIONS Study results show that incompleteness of CoW is not involved in WMH progression.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine and Research Center, Km 2.5 Puntilla-Sambortondón, Universidad Espiritu Santo, Samborondón 092301, Ecuador.
| | - Denisse A Rumbea
- School of Medicine and Research Center, Km 2.5 Puntilla-Sambortondón, Universidad Espiritu Santo, Samborondón 092301, Ecuador
| | - Robertino M Mera
- Biostatistics/Epidemiology, Freenome, Inc., South San Francisco, CA, USA
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Peng L, Shi Y, Ding M, Wei W. A novel method for functional assessment of the circle of Willis before aortic arch surgery. Asian J Surg 2023; 46:3877-3878. [PMID: 37068993 DOI: 10.1016/j.asjsur.2023.03.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 03/28/2023] [Indexed: 04/19/2023] Open
Affiliation(s)
- Ling Peng
- Department of Anesthesiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, China
| | - Yinhui Shi
- Department of Anesthesiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, China
| | - Meng Ding
- Department of Anesthesiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, China
| | - Wei Wei
- Department of Anesthesiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, China.
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Chang W, Li Y, Liu F, Zang K, Zhang P, Qu S, Zhao J, Xue J. Isolation and Cultivation of Vascular Smooth Muscle Cells from the Mouse Circle of Willis. J Vasc Res 2023; 60:234-244. [PMID: 37643584 PMCID: PMC10614493 DOI: 10.1159/000532033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 05/05/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Culturing cerebrovascular smooth muscle cells (CVSMCs) in vitro can provide a model for studying many cerebrovascular diseases. This study describes a convenient and efficient method to obtain mouse CVSMCs by enzyme digestion. METHODS Mouse circle of Willis was isolated, digested, and cultured with platelet-derived growth factor-BB (PDGF-BB) to promote CVSMC growth, and CVSMCs were identified by morphology, immunofluorescence analysis, and flow cytometry. The effect of PDGF-BB on vascular smooth muscle cell (VSMC) proliferation was evaluated by cell counting kit (CCK)-8 assay, morphological observations, Western blotting, and flow cytometry. RESULTS CVSMCs cultured in a PDGF-BB-free culture medium had a typical peak-to-valley growth pattern after approximately 14 days. Immunofluorescence staining and flow cytometry detected strong positive expression of the cell type-specific markers alpha-smooth muscle actin (α-SMA), smooth muscle myosin heavy chain 11 (SMMHC), smooth muscle protein 22 (SM22), calponin, and desmin. In the CCK-8 assay and Western blotting, cells incubated with PDGF-BB had significantly enhanced proliferation compared to those without PDGF-BB. CONCLUSION We obtained highly purified VSMCs from the mouse circle of Willis using simple methods, providing experimental materials for studying the pathogenesis and treatment of neurovascular diseases in vitro. Moreover, the experimental efficiency improved with PDGF-BB, shortening the cell cultivation period.
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Affiliation(s)
- Wei Chang
- Center for Aerospace Clinical Medicine, Department of Aerospace Medicine, Air Force Medical University, Xi’an, China
| | - Yajuan Li
- Center for Aerospace Clinical Medicine, Department of Aerospace Medicine, Air Force Medical University, Xi’an, China
| | - Fengzhou Liu
- Center for Aerospace Clinical Medicine, Department of Aerospace Medicine, Air Force Medical University, Xi’an, China
- Department of Aviation Medicine, Xijing Hospital, Air Force Medical University, Xi’an, China
| | - Kehai Zang
- Center for Aerospace Clinical Medicine, Department of Aerospace Medicine, Air Force Medical University, Xi’an, China
| | - Peiran Zhang
- Department of Biochemistry and Molecular Biology, Air Force Medical University, Xi’an, China
| | - Shuai Qu
- Center for Aerospace Clinical Medicine, Department of Aerospace Medicine, Air Force Medical University, Xi’an, China
| | - Jingyu Zhao
- Department of Aviation Medicine, Xijing Hospital, Air Force Medical University, Xi’an, China
| | - Junhui Xue
- Center for Aerospace Clinical Medicine, Department of Aerospace Medicine, Air Force Medical University, Xi’an, China
- Department of Aviation Medicine, Xijing Hospital, Air Force Medical University, Xi’an, China
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Mihály Z, István L, Czakó C, Benyó F, Borzsák S, Varga A, Magyar-Stang R, Banga PV, Élő Á, Debreczeni R, Kovács I, Sótonyi P. The Effect of Circle of Willis Morphology on Retinal Blood Flow in Patients with Carotid Stenosis Measured by Optical Coherence Tomography Angiography. J Clin Med 2023; 12:5335. [PMID: 37629376 PMCID: PMC10455622 DOI: 10.3390/jcm12165335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/11/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
The Circle of Willis (CoW) is the main collateral system, and its morphological variants are more common in patients who have severe carotid artery stenosis. Earlier data suggest that optical coherence tomography angiography (OCTA) may help to assess the changes in cerebral vascular perfusion by imaging the retinal blood flow. In this single-center prospective clinical study, patients scheduled for carotid endarterectomy (CEA) underwent preoperative computed tomography angiography (CTA) of the extra- and intracranial cerebral circulation. OCTA imaging was performed one week before surgery and postoperatively one month later. The patients were divided into two subgroups based on CTA evaluation of CoW: compromised CoW or non-compromised CoW (containing hypoplastic and normal segments). The effect of the patient's age, OCTA scan quality (SQ), CoW morphology, laterality, and surgery on superficial capillary vessel density (VD) in the macula were assessed in multivariable regression models using linear mixed models. We found that VD significantly decreased with aging (-0.12%; 95%CI: -0.07--0.15; p < 0.001) and was significantly higher in patients with non-compromised CoW morphology (by 0.87% 95%CI (0.26-1.50); p = 0.005). After CEA, retinal blood flow significantly improved by 0.71% (95%CI: 0.18-1.25; p = 0.01). These results suggest that in the case of carotid artery occlusion, patients with non-compromised CoW have more preserved ocular blood flow than subjects with compromised CoW due to remodeling of the intra-orbital blood flow. Measuring the retinal blood flow might be used as a relevant and sensitive indicator of collateral cerebrovascular circulation.
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Affiliation(s)
- Zsuzsanna Mihály
- Department of Vascular and Endovascular Surgery Heart and Vascular Centre, Semmelweis University, 1122 Budapest, Hungary; (Z.M.)
| | - Lilla István
- Department of Ophthalmology, Semmelweis University, 1085 Budapest, Hungary (Á.É.)
| | - Cecilia Czakó
- Department of Ophthalmology, Semmelweis University, 1085 Budapest, Hungary (Á.É.)
| | - Fruzsina Benyó
- Department of Ophthalmology, Semmelweis University, 1085 Budapest, Hungary (Á.É.)
| | - Sarolta Borzsák
- Department of Vascular and Endovascular Surgery Heart and Vascular Centre, Semmelweis University, 1122 Budapest, Hungary; (Z.M.)
| | - Andrea Varga
- Department of Vascular and Endovascular Surgery Heart and Vascular Centre, Semmelweis University, 1122 Budapest, Hungary; (Z.M.)
| | - Rita Magyar-Stang
- Department of Neurology, Semmelweis University, 1085 Budapest, Hungary (R.D.)
| | - Péter Vince Banga
- Department of Vascular and Endovascular Surgery Heart and Vascular Centre, Semmelweis University, 1122 Budapest, Hungary; (Z.M.)
| | - Ágnes Élő
- Department of Ophthalmology, Semmelweis University, 1085 Budapest, Hungary (Á.É.)
| | - Róbert Debreczeni
- Department of Neurology, Semmelweis University, 1085 Budapest, Hungary (R.D.)
| | - Illés Kovács
- Department of Ophthalmology, Semmelweis University, 1085 Budapest, Hungary (Á.É.)
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY 10021, USA
- Department of Clinical Ophthalmology, Faculty of Health Sciences, Semmelweis University, 1085 Budapest, Hungary
| | - Péter Sótonyi
- Department of Vascular and Endovascular Surgery Heart and Vascular Centre, Semmelweis University, 1122 Budapest, Hungary; (Z.M.)
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Zhang B, Wang G, Gao Y, Tan H, Wang P. Influence of the integrity of circle of Willis on asymptomatic or mild patients with first diagnosed chronic internal carotid artery occlusion. Eur J Radiol 2023; 165:110954. [PMID: 37406584 DOI: 10.1016/j.ejrad.2023.110954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/08/2023] [Accepted: 06/29/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND In order to identify individuals with chronic internal carotid artery occlusion (CICAO), it is essential to understand the integrity of the circle of Willis (CoW). This understanding is important as it may determine the potential benefits of active medical and endovascular treatments. PURPOSE The objective of this study is to assess whether diminished integrity of the CoW can serve as a useful marker for identifying individuals with more severe impairment in cerebral blood perfusion and a higher incidence of cerebral infarction among asymptomatic or mildly affected patients with CICAO. MATERIALS AND METHODS We conducted a retrospective review of asymptomatic or mildly affected patients with newly diagnosed CICAO who did not receive reperfusion therapies. The categorization of patients into good or poor integrity groups was based on the assessment of CoW integrity using CTA. We evaluated the volume and value of prolonged time to peak (TTP) in both groups, as well as the occurrence of new cerebral infarctions. Our analysis involved multivariate regression and receiver operating characteristic (ROC) analysis. RESULTS Hemodynamic abnormalities characterized by prolonged TTP were observed in the affected side's blood supply region in all 38 patients. There was a notable difference in the volume and value of prolonged TTP between the two groups (P < 0.001). Correlation analyses based on CTP and CTA parameters revealed a negative relationship between CoW scores and both the abnormal volume (r = -0.624, P = 0.000) and value (r = -0.589, P = 0.000) of prolonged TTP. Upon multivariable adjustment, the independent predictors for new cerebral infarction and higher volume of prolonged TTP were solely the CoW status, with respective estimates of (b = 6.05; 95% confidence interval [CI]: 1.619, 22.619; P = 0.007) and (b = 35.486; 95% CI: 4.697, 268.088; P = 0.001). CONCLUSION Assessing the integrity of the CoW is crucial in evaluating abnormal perfusion in asymptomatic or mildly affected individuals who are newly diagnosed with CICAO and have not undergone reperfusion therapy.
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Affiliation(s)
- Bo Zhang
- Department of Medical Imaging, Tongji Hospital, Tongji University School of Medicine, Shanghai, China No. 389, Xincun Road, Shanghai 200065, China
| | - Guanliansheng Wang
- Department of Medical Imaging, Shanghai TCM-integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China No. 230, Baoding Road, Shanghai 200082, China
| | - Yan Gao
- Department of Medical Imaging, Tongji Hospital, Tongji University School of Medicine, Shanghai, China No. 389, Xincun Road, Shanghai 200065, China
| | - Huaqiao Tan
- Department of Intervention Department, Tongji Hospital, Tongji University School of Medicine, Shanghai, China No. 389, Xincun Road, Shanghai 200065, China
| | - Peijun Wang
- Department of Medical Imaging, Tongji Hospital, Tongji University School of Medicine, Shanghai, China No. 389, Xincun Road, Shanghai 200065, China.
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Rusu MC. Fenestrated P1 segment of posterior cerebral artery, partly duplicated posterior communicating artery. Surg Radiol Anat 2023; 45:761-763. [PMID: 37069448 DOI: 10.1007/s00276-023-03145-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/09/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE Anatomic variations at the junction of primitive internal carotid and basilar arteries are exceedingly rare. We aimed at reporting such rare variants involving the posterior communicating artery (PComA) and the P1 segment of posterior cerebral artery (PCA). METHODS The circle of Willis was dissected in an adult cadaver after removal of the cranial vault and cerebral hemispheres. RESULTS The basilar end was rotated axially to the right. The P1 segment of the right PCA was fenestrated and occupied the interpeduncular fossa. The right PComA passed over the oculomotor nerve to join the anterior arm of the P1 fenestration. On the opposite side, the PComA coursed supero-medially to the oculomotor nerve and it had a partly duplicated posterior end, with two arms, medial, larger, and lateral, thinner, inserting successively into the left PCA. CONCLUSION Extremely rare anatomic variations of the circle of Willis should not be ignored when endovascular or microneurosurgical specific approaches are intended.
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Affiliation(s)
- Mugurel Constantin Rusu
- Division of Anatomy, Faculty of Stomatology, "Carol Davila" University of Medicine and Pharmacy, 8 Eroilor Sanitari Blvd., 050474, Bucharest, Romania.
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20
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Xu X, Ni C, Wu K, Zha M, Sun Y, Wang H, Xu J, Yang K, Guo Y, Huang X, Zhou Z. The relationship between occlusion patterns and outcomes after thrombectomy in patients with acute internal carotid artery occlusion. J Neuroradiol 2023; 50:455-461. [PMID: 37061029 DOI: 10.1016/j.neurad.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND AND PURPOSES Ischemic stroke caused by acute internal carotid artery occlusions (AICO) is usually associated with high disability and mortality. We aimed to investigate whether occlusion patterns significantly influence clinical outcome in patients receiving endovascular thrombectomy (EVT). PATIENTS AND METHODS We performed a retrospective analysis of databases from two comprehensive stroke centers and consecutively investigated patients who had underwent EVT. AICO was defined as acute internal carotid artery occlusions (cervical segment to terminal segment). The clinical characteristics, intervention parameters, and prognosis data were collected. Leptomeningeal collaterals (LMC) were assessed with the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology scale (ASITN/SIRs), graded on a 5-point scale. The occlusion patterns based on Willisian collaterals were categorized into I-type, L-type, and T-type by contralateral carotid artery injections at digital subtraction angiography. Multivariate regression models were applied to evaluate the relationship between occlusion patterns and the prognosis of patients at 90 days after stroke. RESULTS A total of 213 patients were included in the study. Of those,142 (66.7%) achieved successful reperfusion and 64 (30.0%) achieved favorable outcomes at 90 days. Overall, 26 (12.2%), 117 (54.9%), and 70 (32.9%) cases respectively suffered from I-type, L-type, and T-type occlusion. In addition, patients with I-type occlusions had a higher percentage of complete LMC compared with L-type or T-type occlusions (88.5% versus 30.8% versus 27.1%, P< 0.0167). In multivariable logistic regression, we found T-type occlusion was no longer an independent predictor of poor functional outcomes in AICO after adjusting LMC (T versus I, OR, 2.555, 95%CI: 0.717-9.103, P = 0.148; L versus I, OR, 0.815, 95%CI: 0.258-2.574, P = 0.727). CONCLUSIONS For ACIO, occlusion patterns are still a topic that needs attention. Furthermore, compensatory LMC may affect the association between occlusion patterns and functional prognosis in AICO. Occlusion patterns and LMC status distinguish the nature and impact of AICO on expected EVT and subsequent clinical outcomes.
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Affiliation(s)
- Xin Xu
- Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui province, China
| | - Chuyuan Ni
- Department of Neurology, Huangshan City People's Hospital, Huangshan, Anhui province, China
| | - Kangfei Wu
- Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui province, China
| | - Mingming Zha
- Department of Neurology, Jinling Hospital, Affiliated Medical School of Nanjing University
| | - Yi Sun
- Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui province, China
| | - Hao Wang
- Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui province, China
| | - Junfeng Xu
- Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui province, China
| | - Ke Yang
- Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui province, China
| | - Yapeng Guo
- Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui province, China
| | - Xianjun Huang
- Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui province, China.
| | - Zhiming Zhou
- Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui province, China
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Wang H, Shen L, Zhao C, Liu S, Wu G, Wang H, Wang B, Zhu J, Du J, Gong Z, Chai C, Xia S. The incomplete circle of Willis is associated with vulnerable intracranial plaque features and acute ischemic stroke. J Cardiovasc Magn Reson 2023; 25:23. [PMID: 37020230 PMCID: PMC10077703 DOI: 10.1186/s12968-023-00931-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 03/13/2023] [Indexed: 04/07/2023] Open
Abstract
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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Affiliation(s)
- Huiying Wang
- The School of Medicine, Nankai University, Tianjin, 300071, China
| | - Lianfang Shen
- Department of Radiology, First Central Clinical College, Tianjin Medical University, Tianjin, 300192, China
| | - Chenxi Zhao
- Department of Radiology, First Central Clinical College, Tianjin Medical University, Tianjin, 300192, China
| | - Song Liu
- Department of Radiology, Tianjin Huanhu Hospital, Tianjin, 300350, China
| | - Gemuer Wu
- Department of Radiology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010000, China
| | - Huapeng Wang
- Department of Radiology, First Central Clinical College, Tianjin Medical University, Tianjin, 300192, China
| | - Beini Wang
- Department of Radiology, First Central Clinical College, Tianjin Medical University, Tianjin, 300192, China
| | - Jinxia Zhu
- MR Collaboration, Siemens Healthineers Ltd., Beijing, 100102, China
| | - Jixiang Du
- Department of Neurology, School of Medicine, Tianjin First Central Hospital, Nankai University, Tianjin, 300192, China
| | - Zhongying Gong
- Department of Neurology, School of Medicine, Tianjin First Central Hospital, Nankai University, Tianjin, 300192, China.
| | - Chao Chai
- Department of Radiology, School of Medicine, Tianjin First Central Hospital, Nankai University, Tianjin, 300192, China.
- Tianjin Institute of Imaging Medicine, Tianjin, 300192, China.
| | - Shuang Xia
- Department of Radiology, School of Medicine, Tianjin First Central Hospital, Nankai University, Tianjin, 300192, China.
- Tianjin Institute of Imaging Medicine, Tianjin, 300192, China.
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22
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Tong Z, Payne SJ. Investigating spatial variations in dynamic cerebral autoregulation through a computational model of stenosis. Physiol Meas 2023; 44. [PMID: 37015230 DOI: 10.1088/1361-6579/acca5d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 04/04/2023] [Indexed: 04/06/2023]
Abstract
OBJECTIVE Dynamic cerebral autoregulation (dCA) is a well-established mechanism that acts to maintain cerebral blood flow (CBF) reasonably constant in response to short-term fluctuations in blood pressure. It is known to be impaired in many clinical conditions, including stenosis, which is also a major risk factor for ischaemic stroke. However, it is not yet well understood whether impairment in dCA in one brain region is independent or not on dCA impairment in other brain regions, for example, whether there are spatial effects of stenosis on dCA. This is due to the complex blood flow environment and the lack of physiological experiments. 
Approach: We thus establish and apply a novel computational stenosis model including the circle of Willis (CoW) to investigate and to quantify the degree of dCA impairment and CBF patterns as a function of stenosis fraction, measured in different configurations of the cerebral vasculature. 
Main results: We find some evidence for dependence between dCA in different brain regions, although this is very preliminary and much more experimental data will be required to answer this question fully.
Significance: Our study has provided a first attempt to consider the effect of stenosis in various arteries on cerebral autoregulation to investigate spatial variations in dCA. This has potential applications in the treatment of cerebrovascular diseases where the control of cerebral perfusion is critical but where measurements are scarce.
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Affiliation(s)
- Zheng Tong
- Institute of Biomedical Engineering, Department of Engineering Science, Oxford University, Old Road Campus Research Building University of Oxford, Oxford, OX1 2JD, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Stephen John Payne
- Institute of Applied Mechanics, National Taiwan University, 106 No.1, Sec. 4, Roosevelt Rd., Da'an Dist., Taipei City 106, Taiwan (R.O.C.), Taipei, 10617, TAIWAN
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23
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Rusu MC, Vrapciu AD, Lazăr M. A rare variant of accessory posterior cerebral artery. Surg Radiol Anat 2023; 45:523-526. [PMID: 36991211 DOI: 10.1007/s00276-023-03127-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 03/09/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND The posterior cerebral artery (PCA) leaves from the distal end of the basilar artery (BA) and is joined to the internal carotid artery (ICA) by the posterior communicating artery (PComA). METHOD The archived computed tomography angiogram of a 67 y.o. male patient was studied anatomically. RESULTS Anatomically normal PCAs left the BA. Both anterior choroidal arteries were found but the right one was hyperplastic. As the latter distributed parieto-occipital and calcarine branches, it was regarded as an accessory PCA. It was laterally to the normal one, inferior to the vein of Rosenthal. CONCLUSION The terms "accessory PCA" and "hyperplastic anterior choroidal artery" describe the same morphology. Rare anatomical variants could benefit from a homogenous terminology.
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Affiliation(s)
- Mugurel Constantin Rusu
- Division of Anatomy, Faculty of Stomatology, "Carol Davila" University of Medicine and Pharmacy, 8 Eroilor Sanitari Blvd., 050474, Bucharest, Romania
| | - Alexandra Diana Vrapciu
- Division of Anatomy, Faculty of Stomatology, "Carol Davila" University of Medicine and Pharmacy, 8 Eroilor Sanitari Blvd., 050474, Bucharest, Romania.
- University Emergency Hospital Bucharest, Bucharest, Romania.
| | - Mihai Lazăr
- Division of Physiopathology II, Department 2, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021, Bucharest, Romania
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Eskew WH, Cardona JJ, Chaiyamoon A, Carrera A, Reina F, Doğruel Y, Gungor A, Iwanaga J, Dumont AS, Tubbs RS. The Venous Circle of Trolard: An Anatomical Study with Application to Approaches to the Basal Brain. World Neurosurg 2023:S1878-8750(23)00382-0. [PMID: 36940805 DOI: 10.1016/j.wneu.2023.03.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND The arterial circle of Willis is a well-known and interconnecting set of blood vessels at the base of the brain. However, its lesser-known venous counterpart, the circle of Trolard, has had almost no attention in the extant medical literature. METHODS Twenty-four adult human brains underwent dissection of the circle of Trolard. When identified, its component vessels and relationships with adjacent structures were confirmed and documented with photography and measured using microcalipers. RESULTS A complete circle of Trolard was identified on 42% of specimens. Most (64%) incomplete circles were incomplete anteriorly with no anterior communicating vein. The anterior communicating veins joined the anterior cerebral veins superior to the optic chiasm and continued posteriorly. The anterior communicating veins had a mean diameter of 0.45 mm. The length of these veins ranged from 0.8 mm to 1.45 mm. Thirty-six percent of circles were incomplete posteriorly with lack of a posterior communicating vein. The posterior communicating veins were always larger and longer than the anterior cerebral veins. The posterior communicating veins had a mean diameter of 0.8 mm. The length of these veins ranged from 2.8 to 3.9 cm. In general, the circles of Trolard were more or less symmetrical. However, in 2 specimens, asymmetry existed. CONCLUSIONS A better understanding of the venous circle of Trolard might decrease iatrogenic injury during approaches to the base of the brain and improve diagnoses based on imaging of the skull base. To our knowledge, this is the first anatomical study dedicated to the circle of Trolard.
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Affiliation(s)
- William H Eskew
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Juan J Cardona
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA. https://orcid.org/0000-0002-4148-5687
| | - Arada Chaiyamoon
- Department of Anatomy, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Ana Carrera
- Department of Medical Sciences, Clinical Anatomy, Embryology and Neurosciences Research Group, University of Girona, Girona, Spain
| | - Francisco Reina
- Department of Medical Sciences, Clinical Anatomy, Embryology and Neurosciences Research Group, University of Girona, Girona, Spain
| | - Yücel Doğruel
- Microneurosurgery Laboratory Yeditepe University, Istanbul, Turkey
| | - Albuzer Gungor
- Microneurosurgery Laboratory Yeditepe University, Istanbul, Turkey; Department of Neurosurgery, Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Anatomical Sciences, St. George's University, St. George's, West Indies, Grenada; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, Louisiana, USA
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25
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Lapraz P, Pinsard Q, Coudert R, Cortese J, Rouchaud A. Association between flow patterns of the posterior cerebral arterial circle and basilar-tip aneurysms. Surg Radiol Anat 2023; 45:505-511. [PMID: 36894789 DOI: 10.1007/s00276-023-03121-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 02/22/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE The Cerebral arterial circle presents multiple individual anatomical configurations which are of the highest importance regarding the pathological processes for intracranial aneurysms development. Previous studies highlighted the importance of geometry and especially arterial bifurcations leading to aneurysms development. The primary objective of this study was to determine whether a flow pattern asymmetry of the P1 segments of the posterior cerebral arteries was associated with a higher risk of basilar tip aneurysm. MATERIAL AND METHODS Two different populations were retrospectively reviewed. The first population, without aneurysm, for which TOF MRI sequences were reviewed. The second population with patients harboring basilar tip aneurysms for whom cerebral angiograms were reviewed. We retrospectively analyzed the flow contribution and symmetry of the two right and left P1 segments of the posterior cerebral arteries and the two posterior communicating arteries (Pcomm). We analyzed the association and risk factors for basilar tip aneurysm. RESULTS The anatomical and flow configurations of P1 and Pcomm have been reviewed in 467 patients without aneurysms and 35 patients with aneurysms. We identified a significant association between the flow pattern asymmetry of the P1 segments and the presence of a basilar tip aneurysm (OR = 2.12; IC95% = [1.01-4.36]; p = 0.04). We also confirmed that the male gender was protective against aneurysm (OR = 0.45; IC95% = [0.194-0.961]; p = 0.04). CONCLUSION Non-modal basilar tip bifurcation and flow asymmetry of P1 segments are associated with an increased risk of basilar tip aneurysm. These findings highlight the importance of analyzing MRI-TOF of the posterior configuration of the Cerebral arterial circle to potentially refine the aneurysms risk prediction.
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Affiliation(s)
- Pierre Lapraz
- Department of Human Anatomy, Laboratoire d'Anatomie, Faculty of Medicine, University of Limoges, 2, rue du Docteur Marcland, 87025, Limoges, France
| | - Quentin Pinsard
- Department of Human Anatomy, Laboratoire d'Anatomie, Faculty of Medicine, University of Limoges, 2, rue du Docteur Marcland, 87025, Limoges, France
| | - Romain Coudert
- Department of Radiology, Limoges University Hospital, CHU Dupuytren, 2, Avenue Martin-Luther-King, 87000, Limoges, France
| | - Jonathan Cortese
- Department of Interventional Neuroradiology-NEURI Brain Vascular Center, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Aymeric Rouchaud
- Department of Radiology, Limoges University Hospital, CHU Dupuytren, 2, Avenue Martin-Luther-King, 87000, Limoges, France. .,UMR 7252, University of Limoges, XLIM CNRS, 87000, Limoges, France.
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Abstract
Despite successful recanalization, reperfusion failure associated with poor neurological outcomes develops in half of treated stroke patients. We explore here whether spreading depolarization (SD) is a predictor of reperfusion failure. Global forebrain ischemia/reperfusion was induced in male and female C57BL/6 mice (n = 57). SD and cerebral blood flow (CBF) changes were visualized with transcranial intrinsic optical signal and laser speckle contrast imaging. To block SD, MK801 was applied (n = 26). Neurological deficit, circle of Willis (CoW) anatomy and neuronal injury were evaluated 24 hours later. SD emerged after ischemia onset in one or both hemispheres under a perfusion threshold (CBF drop to 21.1 ± 4.6 vs. 33.6 ± 4.4%, SD vs. no SD). The failure of later reperfusion (44.4 ± 12.5%) was invariably linked to previous SD. In contrast, reperfusion was adequate (98.9 ± 7.4%) in hemispheres devoid of SD. Absence of the P1 segment of the posterior cerebral artery in the CoW favored SD occurrence and reperfusion failure. SD occurrence and reperfusion failure were associated with poor neurologic function, and neuronal necrosis 24 hours after ischemia. The inhibition of SD significantly improved reperfusion. SD occurrence during ischemia impairs later reperfusion, prognosticating poor neurological outcomes. The increased likelihood of SD occurrence is predicted by inadequate collaterals.
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Affiliation(s)
- Anna Törteli
- Hungarian Centre of Excellence for Molecular Medicine - University of Szeged, Cerebral Blood Flow and Metabolism Research Group, Szeged, Hungary.,Department of Cell Biology and Molecular Medicine, Albert Szent-Györgyi Medical School and Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - Réka Tóth
- Hungarian Centre of Excellence for Molecular Medicine - University of Szeged, Cerebral Blood Flow and Metabolism Research Group, Szeged, Hungary.,Department of Cell Biology and Molecular Medicine, Albert Szent-Györgyi Medical School and Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - Sarah Berger
- Department of Cell Biology and Molecular Medicine, Albert Szent-Györgyi Medical School and Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - Sarah Samardzic
- Department of Cell Biology and Molecular Medicine, Albert Szent-Györgyi Medical School and Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - Ferenc Bari
- Department of Medical Physics and Informatics, Albert Szent-Györgyi Medical School and Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - Ákos Menyhárt
- Hungarian Centre of Excellence for Molecular Medicine - University of Szeged, Cerebral Blood Flow and Metabolism Research Group, Szeged, Hungary.,Department of Cell Biology and Molecular Medicine, Albert Szent-Györgyi Medical School and Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - Eszter Farkas
- Hungarian Centre of Excellence for Molecular Medicine - University of Szeged, Cerebral Blood Flow and Metabolism Research Group, Szeged, Hungary.,Department of Cell Biology and Molecular Medicine, Albert Szent-Györgyi Medical School and Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
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Feng L, Mao HJ, Zhang DD, Zhu YC, Han F. Anatomical variations in the Circle of Willis and the formation and rupture of intracranial aneurysms: A systematic review and meta-analysis. Front Neurol 2023; 13:1098950. [PMID: 36726753 PMCID: PMC9885143 DOI: 10.3389/fneur.2022.1098950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/30/2022] [Indexed: 01/17/2023] Open
Abstract
Background The anterior (AcomA) and posterior communicating arteries (PcomA) are two of the most frequent sites for intracranial aneurysms. Anatomical variations in the Circle of Willis (COW) are frequently observed in patients with AcomA and PcomA aneurysms. Strong evidence is needed to determine the pooled estimate of the effect of COW variations on the formation and rupture of these aneurysms. Aim This systematic review and meta-analysis aimed to establish the effect of COW variations on the formation and rupture of AcomA and PcomA aneurysms using available studies. Summary of review PubMed, Embase, and Web of Science databases were systematically searched for studies published in English before September 21, 2022. Studies investigating AcomA aneurysms and the hypoplastic/aplastic A1 segment of the anterior cerebral artery and PcomA aneurysms and hypoplastic/aplastic PcomA or fetal-type posterior cerebral artery (FTP) were included. The heterogeneity of the studies was assessed using Cochran Q-test and I2 statistic. Pooled estimate was assessed using either a random- or fixed-effects model based on the heterogeneity of the studies. Among the 4,932 studies, 21 were eligible and included in the analysis. The presence of hypoplastic/aplastic A1 was significantly correlated with the formation [OR (95% confidence interval [CI]) = 7.97 (5.58, 11.39), P < 0.001] and rupture [OR (95%CI) = 1.87 (1.29, 2.72), P < 0.001] of AcomA aneurysms. Significant associations between FTP and both the formation [OR (95%CI) = 2.15 (1.41, 3.30), P < 0.001] and rupture [OR (95%CI) = 1.72 (1.26, 2.36), P < 0.001] of PcomA aneurysms were observed. Conclusions Significant associations were observed between COW variations and both the formation and rupture of AcomA and PcomA aneurysms. This can help in determining interventions for patients with aneurysms. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=225149, identifier: CRD42021225149.
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Affiliation(s)
- Lu Feng
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - He-Jiao Mao
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ding-Ding Zhang
- Central Research Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi-Cheng Zhu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei Han
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,*Correspondence: Fei Han ✉
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Tatit RT, Ogilvy CS, Shutran MS, Tawk RG, Yasuda TA, Baccin CE. Plasticity of the adult circle of Willis in response to flow diversion stents. Surg Neurol Int 2023; 14:49. [PMID: 36895205 PMCID: PMC9990810 DOI: 10.25259/sni_1139_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 01/28/2023] [Indexed: 02/12/2023] Open
Abstract
Background We present five patients with remodeling of the adult circle of Willis in response to flow diverter stents (FDSs) at the anterior communicating artery (AComA) and the posterior communicating artery (PComA). The observed changes provide a paradigm of how flow change can institute anatomic changes in the adult circle of Willis vasculature. Case Description In the first two cases, after placement of the FDS covering the AComA, there was an increase in size and flow of the contralateral A1-anterior cerebral artery which had previously been hypoplastic. In one of the cases, this led to the filling of the aneurysm and required placement of coils within the lesion which was curative. In case three, the FDS effect led to asymptomatic occlusion of the PComA and associated aneurysm without change of the ipsilateral P1-segement of posterior-cerebral-artery (P1-PCA) caliber. In the fourth case, the FDS covering an aneurysm with a fetal PCA arising from its neck resulted in significant reduction of the aneurysm size, persistent flow and caliber of the fetal PCA, and the hypoplastic ipsilateral P1-PCA. Finally, in the fifth case, after FDS occlusion of the PComA and aneurysm there was increasement in diameter of the ipsilateral P1-PCA that was previously hypoplastic. Conclusion The use of FDS can affect vessels covered by the device and other arteries of the circle of Willis adjacent to the FDS. The phenomena illustrated in the hypoplastic branches appear to be a compensatory response to the hemodynamic changes induced by the divertor and to the altered flow in the circle of Willis.
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Affiliation(s)
- Rafael Trindade Tatit
- Department of Medicine, Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil
| | - Christopher S Ogilvy
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Max S Shutran
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Rabih G Tawk
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, United States
| | - Thomas A Yasuda
- Department of Interventional Neuroradiology, Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - Carlos Eduardo Baccin
- Department of Interventional Neuroradiology, Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil
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Mendoza S, Scalzo F, Chien A. Determining and Validating Population Differences in Magnetic Resonance Angiography Using Sparse Representation. Proceedings (IEEE Int Conf Bioinformatics Biomed) 2022; 2022:3101-3108. [PMID: 37179739 PMCID: PMC10170968 DOI: 10.1109/bibm55620.2022.9994989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Goal Identifying population differences can serve as an insightful tool for diagnostic radiology. To do so, a reliable preprocessing framework and data representation are vital. Methods We build a machine learning model to visualize gender differences in the circle of Willis (CoW), an integral part of the brain's vasculature. We start with a dataset of 570 individuals and process them for analysis using 389 for the final analysis. Results We find statistical differences between male and female patients in one image plane and visualize where they are. We can see differences between the right and left-hand sides of the brain confirmed using Support Vector Machines (SVM). Conclusion This process can be applied to detect population variations in the vasculature automatically. Significance It can guide debugging and inferring complex machine learning algorithms such as SVM and deep learning models.
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Affiliation(s)
- Steve Mendoza
- Department of Radiological Science, David Geffen School of Medicine at UCLA
| | - Fabien Scalzo
- Department of Computer Science, Seaver College of Natural Sciences, Pepperdine University, Malibu, United State of America
| | - Aichi Chien
- Department of Radiological Science, David Geffen School of Medicine at UCLA
- Corresponding author Aichi Chien, PhD, Department of Radiological Science, David Geffen School of Medicine at UCLA, 10833 LeConte Ave, Box 957350 Los Angeles, CA 90095.
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Feng L, Zhai FF, Li ML, Zhou LX, Ni J, Yao M, Jin ZY, Cui LY, Zhang SY, Han F, Zhu YC. Association between Anatomical Variations of the Circle of Willis and Covert Vascular Brain Injury in the General Population. Cerebrovasc Dis 2022; 52:480-486. [PMID: 36446342 PMCID: PMC10568604 DOI: 10.1159/000527432] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/05/2022] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND AND PURPOSE The circle of Willis (COW) is a circulatory anastomosis located at the base of the brain. Little is known about the association between covert vascular brain injury and COW configurations in the general population. We explored this relationship in a community-based Chinese sample. METHODS A total of 1,055 patients (mean age, 54.8 ± 8.9 years; 36.0% men) without intracranial arterial stenosis were included in the analysis. Magnetic resonance imaging was performed to evaluate the presence of imaging markers of covert vascular brain injury, including white matter hyperintensities (WMHs), lacunes, cerebral microbleeds (CMBs), enlarged perivascular spaces, and brain atrophy. Magnetic resonance angiography was used to classify the COW configurations according to the completeness, symmetry, and presence of the fetal posterior cerebral artery (FTP). The association between vascular lesions and variations in COW was analyzed. RESULTS Among the 1,055 patients, 104 (9.9%) had a complete COW. Completeness correlated with age (p = 0.001). Incomplete COW was positively associated with WMH severity (OR = 2.071; 95% CI, 1.004-4.270) and CMB presence (OR = 1.542; 95% CI, 1.012-2.348), independent of age and sex. The presence of FTP was associated with lacunes (OR = 1.878; 95% CI, 1.069-3.298), more severe WMHs (OR = 1.739; 95% CI, 1.064-2.842), and less severe enlarged perivascular spaces (OR = 0.562; 95% CI, 0.346-0.915). CONCLUSIONS COW configuration was significantly related to various covert vascular brain injuries.
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Affiliation(s)
- Lu Feng
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Fei-Fei Zhai
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Ming-Li Li
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Li-Xin Zhou
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Jun Ni
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Ming Yao
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Zheng-Yu Jin
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Li-Ying Cui
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Shu-Yang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Fei Han
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Yi-Cheng Zhu
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
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Dumais F, Caceres MP, Janelle F, Seifeldine K, Arès-Bruneau N, Gutierrez J, Bocti C, Whittingstall K. eICAB: A novel deep learning pipeline for Circle of Willis multiclass segmentation and analysis. Neuroimage 2022; 260:119425. [PMID: 35809887 DOI: 10.1016/j.neuroimage.2022.119425] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/22/2022] [Accepted: 06/29/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The accurate segmentation, labeling and quantification of cerebral blood vessels on MR imaging is important for basic and clinical research, yet results are not generalizable, and often require user intervention. New methods are needed to automate this process. PURPOSE To automatically segment, label and quantify Circle of Willis (CW) arteries on Magnetic Resonance Angiography images using deep convolutional neural networks. MATERIALS AND METHODS MRA images were pooled from three public and private databases. A total of 116 subjects (mean age 56 years ± 21 [standard deviation]; 72 women) were used to make up the training set (N=101) and the testing set (N=15). In each image, fourteen arterial segments making up or surrounding the CW were manually annotated and validated by a clinical expert. Convolutional neural network (CNN) models were trained on a training set to be finally combined in an ensemble to develop eICAB. Model performances were evaluated using (1) quantitative analysis (dice score on test set) and (2) qualitative analysis (external datasets, N=121). The reliability was assessed using multiple MRAs of healthy participants (ICC of vessel diameters and volumes on test-retest). RESULTS Qualitative analysis showed that eICAB correctly predicted the large, medium and small arteries in 99±0.4%, 97±1% and 88±7% of all images, respectively. For quantitative assessment, the average dice score coefficients for the large (ICAs, BA), medium (ACAs, MCAs, PCAs-P2), and small (AComm, PComm, PCAs-P1) vessels were 0.76±0.07, 0.76±0.08 and 0.41±0.27, respectively. These results were similar and, in some cases, statistically better (p<0.05) than inter-expert annotation variability and robust to image SNR. Finally, test-retest analysis showed that the model yielded high diameter and volume reliability (ICC=0.99). CONCLUSION We have developed a quick and reliable open-source CNN-based method capable of accurately segmenting and labeling the CW in MRA images. This method is largely independent of image quality. In the future, we foresee this approach as a critical step towards fully automated analysis of MRA databases in basic and clinical research.
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Affiliation(s)
- Félix Dumais
- Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Science, Université de Sherbrooke, 3001 12e Avenue N, Sherbrooke, Québec J1H 5H3, Canada.
| | - Marco Perez Caceres
- Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Science, Université de Sherbrooke, 3001 12e Avenue N, Sherbrooke, Québec J1H 5H3, Canada
| | - Félix Janelle
- Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Science, Université de Sherbrooke, 3001 12e Avenue N, Sherbrooke, Québec J1H 5H3, Canada
| | - Kassem Seifeldine
- Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Science, Université de Sherbrooke, 3001 12e Avenue N, Sherbrooke, Québec J1H 5H3, Canada
| | - Noémie Arès-Bruneau
- Department of Medecine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Jose Gutierrez
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Christian Bocti
- Department of Medecine, Université de Sherbrooke, Sherbrooke, Québec, Canada; Research Center on Aging, CIUSSS de l'Estrie - CHUS, Sherbrooke, Québec, Canada; Department of Neurology, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Kevin Whittingstall
- Department of Radiology, Université de Sherbrooke, Sherbrooke, Québec, Canada
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Kwon B, Song Y, Choi YH, Suh DC. Physiologic Flow Diversion Coiling Technique for Wide-Necked Aneurysms with an Asymmetric Bidirectional Flow at the Aneurysm Neck. Neurointervention 2022; 17:133-142. [PMID: 36167347 DOI: 10.5469/neuroint.2022.00311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/27/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Wide-necked aneurysms in the circle of Willis (CoW) are prone to recur due to reciprocal bidirectional flow. We present a novel concept of coil embolization to prevent recurrence that uses physiologic flow diversion at the CoW. MATERIALS AND METHODS We enrolled 14 patients (15 aneurysms) who underwent aneurysm coiling for wide-necked aneurysms with asymmetric bidirectional inflow into the aneurysm. Four patients had recurrent aneurysms after coiling. The concept of physiologic flow diversion included obliterating antegrade flow into the aneurysm sac as well as opposite CoW flow by performing compact coil packing with intentional protrusion out of the aneurysm neck to the communicating part. RESULTS Fifteen aneurysms, including 4 recurrent aneurysms, in an anterior communicating artery (n=7), posterior communicating artery (n=5), and tip of the basilar artery (n=3) were treated with coil embolization (n=10) and stent-assisted coiling (n=5). All aneurysms had a wide neck, and the mean largest diameter was 9.0 mm. The mean packing density was 45.1%. Twelve aneurysms were completely occluded, and 3 aneurysms had tiny residual neck remnants. There was neither a neurological event nor recurrence during the mean 12.5 months of follow-up. CONCLUSION Wide-necked aneurysms at the CoW tend to recur. As a strategy to prevent a recurrence, physiologic flow diversion can be an option in treating wide-necked aneurysms in the CoW.
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Affiliation(s)
- Boseong Kwon
- Neurointervention Clinic, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yunsun Song
- Neurointervention Clinic, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yun Hyeok Choi
- Neurointervention Clinic, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae Chul Suh
- Neurointervention Clinic, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Department of Neurointervention, GangNam St. Peter's Hospital, Seoul, Korea
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Abstract
Thomas Willis was born four hundred years ago on 27 January 1621 in Wiltshire. He has been dubbed 'the father of neurology' and is remembered for the Circle of Willis at the base of the brain. Young Thomas was educated at Oxford as a schoolboy and undergraduate. From 1646 he practised medicine and studied chemistry; he joined the Oxford Experimental Philosophical Club, and was Sedleian Professor of Natural Philosophy from 1660. He established a prosperous medical practice at The Angel on Oxford High Street, and achieved international acclaim for Cerebri anatome (1664). Lured to London in 1667, Willis lived in style but attended the sick poor on Sundays and worshipped twice daily at St Martin-in-the-Fields.
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Lin E, Kamel H, Gupta A, RoyChoudhury A, Girgis P, Glodzik L. Incomplete circle of Willis variants and stroke outcome. Eur J Radiol 2022; 153:110383. [PMID: 35661459 PMCID: PMC9948548 DOI: 10.1016/j.ejrad.2022.110383] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/07/2022] [Accepted: 05/25/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND There is considerable variation in circle of Willis morphology among the general population, and these variations have been correlated with risk of aneurysms, cerebral ischemia, and other clinical events. PURPOSE To investigate the relationship between circle of Willis variants and stroke outcome. MATERIALS AND METHODS We performed a retrospective study involving 297 patients from our institution's acute stroke academic registry. All received MRA examinations of the head upon admission for acute strokes. All imaging was reviewed to assess for circle of Willis variants (particularly A1 and P1 aplasia or hypoplasia) along with vertebral artery aplasia or hypoplasia. Stroke outcome was defined as good (walking independently at the time of discharge) or poor (inability to walk at discharge, assistance needed to walk at discharge, or death). Severity of stroke was assessed using the National Institute of Health Stroke Scale. RESULTS An incomplete circle of Willis was seen in 34% of subjects. There was no significant association between age, gender, hypertension, or presence of arterial stenosis and circle of Willis completeness. Using logistic regression, we found that the presence of an incomplete circle of Willis decreased the odds of a stroke patient having a good outcome by 47% (p = 0.046, OR 0.53, 95% CI 0.281-0.988), after adjusting for age and severity of stroke at admission. CONCLUSION This study suggests that an incomplete circle of Willis may be associated with a poorer prognosis for stroke patients.
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Affiliation(s)
- Eaton Lin
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA.
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Ajay Gupta
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA,Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Arindam RoyChoudhury
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Peter Girgis
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Lidia Glodzik
- Brain Health Imaging Institute, Department of Radiology, Weill Cornell Medicine, New York, NY, USA
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Chopra T, Neuberger I, Prince E, White C, Maloney J, Stence N, Mirsky D. Age-related changes in the completeness of the circle of Willis in children. Childs Nerv Syst 2022; 38:1181-1184. [PMID: 35394211 DOI: 10.1007/s00381-022-05505-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/16/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The circle of Willis is a circulatory anastomosis that supplies blood to the brain. If any of the bridging segments are hypoplastic or absent, the capacity for collateral flow in the setting of large vessel occlusion may be decreased. Outside of the neonatal period, the prevalence of a complete circle of Willis (CoW) in the pediatric population has not been well described. Our objectives include determining the prevalence of a complete CoW in children and identifying if there is an age-related "loss" of arterial segments. METHODS Following IRB approval, angiograms of the CoW performed on a 3-T MR platform from 2016 to 2020 on patients 21 years or younger were retrospectively reviewed. Any patient with underlying arterial pathology that may affect the CoW was excluded. Patient age and gender at the time of imaging were obtained. RESULTS In total, 592 pediatric CoW were assessed. Frequencies of completeness were calculated in two different fashions: scenario 1 where a CoW was characterized as complete even if it contained hypoplastic vessels (88.8%), and scenario 2 where it was characterized as complete after excluding hypoplastic vessels (44.0%). In both scenarios, our data showed that older age was more associated with an incomplete CoW (p < 0.0001). In addition, we found a higher percentage of males with an incomplete CoW compared with females (p < 0.0001). CONCLUSIONS The presence of a complete CoW is greater in our pediatric population than what has been reported in adults. The prevalence of an incomplete circle of Willis also increases significantly with age.
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Affiliation(s)
- Tavishi Chopra
- Creighton University School of Medicine, AZ, Phoenix, USA.
| | | | - Eric Prince
- University of Colorado Anschutz Medical Campus, Aurora, USA
| | | | - John Maloney
- Neuroradiology, Children's Hospital Colorado, Aurora, USA
| | | | - David Mirsky
- Neuroradiology, Children's Hospital Colorado, Aurora, USA
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Llopis G, Quinones S, Konschake M, Simon De Blas C, Hernández LM, Abramovic A, Viñuela-Prieto JM, Sanudo J, Tubbs RS, Maranillo E. ATHEROMATOSIS OF THE BRAIN-SUPPLYING ARTERIES: CIRCLE OF WILLIS, BASILAR, VERTEBRAL AND THEIR BRANCHES. Ann Anat 2022; 243:151941. [PMID: 35378255 DOI: 10.1016/j.aanat.2022.151941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE Atherosclerotic plaques in the brain-supplying arteries are slowly-developing alterations of vascular structures that can lead to neurological impairment due to stenosis and insufficient oxygenation of eloquent brain areas. The aim of this study is to provide detailed demographic information related to the incidence of atherosclerotic plaques in the cerebral arteries. MATERIAL AND METHODS Forty-eight circles of Willis (21 men, 21 women, mean age: 70.26, six samples unknown) were macroscopically analyzed for length, diameter, and presence of atherosclerotic plaques. Statistical analysis was used to identify potential differences in the locations and frequencies of atherosclerotic plaques in relation to age and sex. RESULTS The study sample revealed 261 atherosclerotic plaques. The key findings were significant correlations between plaque development and age and between plaque location and age; however, there was no significant sex difference. CONCLUSION The upper and lower branches of the middle cerebral artery (MCA) were novel locations predisposing to plaque development. A cut-off value at 60 years revealed a significant difference in plaque development and distribution. There were no significant sex differences in the occurrence of atherosclerotic plaques.
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Affiliation(s)
- G Llopis
- Department of Anatomy and Embryology, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - S Quinones
- Department of Anatomy and Embryology, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - M Konschake
- Institute of Clinical and Functional Anatomy, Medical University of Innsbruck (MUI), Innsbruck, Austria.
| | - C Simon De Blas
- Department of Computer Science and Statistics, Universidad Rey Juan Carlos, Madrid, Spain
| | - L M Hernández
- Department of Human Anatomy and Embryology, School of Medicine, Alcalá University of Madrid, Madrid, Spain
| | - A Abramovic
- Institute of Clinical and Functional Anatomy, Medical University of Innsbruck (MUI), Innsbruck, Austria; Department of Neurosurgery, Medical University of Innsbruck (MUI), Innsbruck, Austria
| | | | - J Sanudo
- Department of Anatomy and Embryology, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - R S Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA; Department of Anatomical Sciences, St. George's University, Grenada; Department of Neurology, Tulane University School of Medicine, New Orleans, LA, USA; Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA; Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - E Maranillo
- Department of Anatomy and Embryology, School of Medicine, Complutense University of Madrid, Madrid, Spain
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Fan W, Shi W, Guo W, Zhang Y, Tan J, Yu B. Independent role of circle of Willis for peri-procedural evaluation of carotid endarterectomy in patients with severe carotid stenosis. Clin Neurol Neurosurg 2021; 213:107102. [PMID: 34999387 DOI: 10.1016/j.clineuro.2021.107102] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 11/21/2021] [Accepted: 12/15/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVES In patients with severe carotid stenosis (CS), collateral circulation via circle of Willis (CoW) is considered a compensatory response to maintain blood flow. The aim of this study was to evaluate the impact of CoW in patients with severe CS throughout carotid endarterectomy (CEA). METHODS A database of patients (n = 124) undergoing CEA was sampled from 2013 to 2020. Severe CS was defined as 90-99% caliber stenosis and collateral circulation was identified by CoW opening. Baseline characteristics, Age-related white matter change (ARWMC) score, immediate neurologic events (INEs) and manifestations were recorded and compared. Correlation and regression analysis for CoW were further investigated. RESULTS All patients enrolled were divided into two groups regarding to the visualized CoW opening and complete CoW was noticed in 57 patients. The prevalence of complete CoW was higher among asymptomatic patients (n = 39, 68.4%), while higher percentage of TIA or previous stroke were noticed in incomplete CoW (n = 45, 67.2%). Patients with incomplete CoW had a significantly higher median ARWMC score and remarkable cerebral perfusion deficit (P < 0.05*). Totally, 4 INEs (6.0%) were noted in patients with incomplete CoW after CEA. Cerebral hyperperfusion syndrome (CHS) was noticed in 10 patients and early-phase of postoperative hypertension (EPOH) in 15 ones with incomplete CoW versus patients with complete CoW (14.9% and 22.4% vs 3.5% and 7.0%, P < 0.05). Correlation analysis showed strong relationship between CoW opening and peri-operative factors like pre-operative symptoms, ARWMC, CHS and EPOH (P < 0.05*). Overall, CoW opening was an independent predictor of both CHS and EPOH (95% CI, 0.021-0.715 and 0.060-0.949, P < 0.05*) with logistic regression. CONCLUSIONS Sufficient collateral circulation via CoW may promote ipsilateral cerebral perfusion and mitigate WMC in patients with severe CS. In addition, collaterals may improve the predictive power of the risk scale for post-procedural complications after CEA.
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Solak S, Ustabasioglu FE, Alkan A, Kula O, Sut N, Tuncbilek N. Anatomical variations of the circle of Willis in children. Pediatr Radiol 2021; 51:2581-7. [PMID: 34410451 DOI: 10.1007/s00247-021-05167-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 05/20/2021] [Accepted: 07/31/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The morphology of the circle of Willis in adults has been thoroughly discussed in scientific literature. However, the morphology of the circle of Willis in pediatric patients is under-researched. OBJECTIVES We aimed to establish reference data for the morphology and variations of the circle of Willis in a population consisting of all pediatric age subgroups and to evaluate the possible temporal evolution of the circle of Willis in pediatric patients along with the variations between pediatric and adult populations. MATERIALS AND METHODS Our patient cohort included 263 pediatric patients ages 1-215 months. A total of 273 magnetic resonance (MR) angiography images were retrospectively analyzed for all circle of Willis vessels to compare the incidence of complete cases and variation frequency based on gender and age group. RESULT In our study of 273 MR angiograms from all age ranges in the pediatric population, we found a 56.1% circle of Willis completion rate. Overall completion rates were statistically significantly higher in the toddler and preschool age groups. The lowest completion rate was in the newborn-infant group (40%). CONCLUSION Circle of Willis completion rates and variations in pediatric populations are similar to those in adult populations; completion rates rise in toddler and preschooler age groups and decline as children grow into the school-age and adolescent period.
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Hossain SS, Starosolski Z, Sanders T, Johnson MJ, Wu MCH, Hsu MC, Milewicz DM, Annapragada A. Image-based patient-specific flow simulations are consistent with stroke in pediatric cerebrovascular disease. Biomech Model Mechanobiol 2021; 20:2071-2084. [PMID: 34283347 PMCID: PMC8666092 DOI: 10.1007/s10237-021-01495-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Abstract
Moyamoya disease (MMD) is characterized by narrowing of the distal internal carotid artery and the circle of Willis (CoW) and leads to recurring ischemic and hemorrhagic stroke. A retrospective review of data from 50 pediatric MMD patients revealed that among the 24 who had a unilateral stroke and were surgically treated, 11 (45.8%) had a subsequent, contralateral stroke. There is no reliable way to predict these events. After a pilot study in Acta-/- mice that have features of MMD, we hypothesized that local hemodynamics are predictive of contralateral strokes and sought to develop a patient-specific analysis framework to noninvasively assess this stroke risk. A pediatric MMD patient with an occlusion in the right middle cerebral artery and a right-sided stroke, who was surgically treated and then had a contralateral stroke, was selected for analysis. By using an unsteady Navier-Stokes solver within an isogeometric analysis framework, blood flow was simulated in the CoW model reconstructed from the patient's postoperative imaging data, and the results were compared with those from an age- and sex-matched control subject. A wall shear rate (WSR) > 60,000 s-1 (about 12 × higher than the coagulation threshold of 5000 s-1 and 9 × higher than control) was measured in the terminal left supraclinoid artery; its location coincided with that of the subsequent postsurgical left-sided stroke. A parametric study of disease progression revealed a strong correlation between the degree of vascular morphology altered by MMD and local hemodynamic environment. The results suggest that an occlusion in the CoW could lead to excessive contralateral WSRs, resulting in thromboembolic ischemic events, and that WSR could be a predictor of future stroke.
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Affiliation(s)
- Shaolie S Hossain
- Molecular Cardiology Research Laboratory, Texas Heart Institute, 6770 Bertner Avenue, Houston, TX, 77030, USA.
- Oden Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, TX, USA.
| | - Zbigniew Starosolski
- Translational Imaging Group, Texas Children's Hospital, Houston, TX, USA
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Travis Sanders
- Oden Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, TX, USA
| | - Michael J Johnson
- Oden Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, TX, USA
| | - Michael C H Wu
- Department of Mechanical Engineering, Iowa State University, Ames, IA, USA
| | - Ming-Chen Hsu
- Department of Mechanical Engineering, Iowa State University, Ames, IA, USA
| | - Dianna M Milewicz
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center Houston, Houston, TX, USA
| | - Ananth Annapragada
- Translational Imaging Group, Texas Children's Hospital, Houston, TX, USA
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
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Ariyada K, Shibahashi K, Fujika N, Sakakura Y, Hanakawa K, Murao M. Posterior Communicating Artery Hypoplasia: A Risk Factor for Vertebral Artery Dissection Causing Subarachnoid Hemorrhage. J Stroke Cerebrovasc Dis 2021; 31:106224. [PMID: 34839234 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/29/2021] [Accepted: 11/08/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Subarachnoid hemorrhage due to vertebral artery dissection is often fatal; however, its anatomical predictors remain unclear. We conducted a retrospective hospital-based case-control study to evaluate whether variations in the posterior communicating artery are associated with the risk of vertebral artery dissection with subarachnoid hemorrhage. MATERIALS AND METHODS We obtained data from patients who underwent computed tomography angiography at our hospital between April 2010 and March 2020. Based on the connection between the anterior and posterior circulation of the arterial circle of Willis, the patients were categorized into a separated group (posterior communicating artery hypoplasia) and a connected group (all others). We evaluated the association between the development of posterior communicating artery and subarachnoid hemorrhage due to vertebral artery dissection using multivariate logistic regression analysis. RESULTS Thirty-eight patients had subarachnoid hemorrhage due to vertebral artery dissection and 76 were identified as age- and sex-matched controls. In conditional multivariate logistic regression analysis, the separated group showed a significant association with subarachnoid hemorrhage due to vertebral artery dissection, with an adjusted odds ratio of 2.8 (95% confidence interval, 1.2-6.5; P = 0.021). CONCLUSIONS The present study demonstrates that posterior communicating artery hypoplasia may be associated with subarachnoid hemorrhage due to vertebral artery dissection. Our results highlight the importance of anatomical variations in the cerebral artery and provide evidence to help develop preventive measures against strokes.
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Affiliation(s)
- Kenichi Ariyada
- Department of Neurosurgery, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo 130-8575, Japan.
| | - Keita Shibahashi
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Naoshi Fujika
- Department of Neurosurgery, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo 130-8575, Japan
| | - Yuya Sakakura
- Department of Neurosurgery, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo 130-8575, Japan
| | - Kazuo Hanakawa
- Department of Neurosurgery, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo 130-8575, Japan
| | - Masahiko Murao
- Department of Neurosurgery, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo 130-8575, Japan
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Bonnin P, Kubis N, Charriaut-Marlangue C. Collateral Supply in Preclinical Cerebral Stroke Models. Transl Stroke Res 2021; 13:512-527. [PMID: 34797519 PMCID: PMC9232412 DOI: 10.1007/s12975-021-00969-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/08/2021] [Accepted: 11/11/2021] [Indexed: 02/01/2023]
Abstract
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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Affiliation(s)
- Philippe Bonnin
- APHP, Physiologie Clinique - Explorations Fonctionnelles, Hôpital Lariboisiere, Université de Paris, 2 rue Ambroise Paré, F-75010, Paris, France. .,INSERM U1148, LVTS, Hôpital Bichat, Université de Paris, F-75018, Paris, France.
| | - Nathalie Kubis
- APHP, Physiologie Clinique - Explorations Fonctionnelles, Hôpital Lariboisiere, Université de Paris, 2 rue Ambroise Paré, F-75010, Paris, France.,INSERM U1148, LVTS, Hôpital Bichat, Université de Paris, F-75018, Paris, France
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Toussaint L, Peters S, Mikkelsen R, Karabegovic S, Bäumer C, Muren LP, Tram-Henriksen L, Høyer M, Lassen-Ramshad Y, Timmermann B. Delineation atlas of the Circle of Willis and the large intracranial arteries for evaluation of doses to neurovascular structures in pediatric brain tumor patients treated with radiation therapy. Acta Oncol 2021; 60:1392-1398. [PMID: 34213401 DOI: 10.1080/0284186x.2021.1945679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Survivors of pediatric brain tumors are susceptible to neurovascular disease after radiotherapy, with dose to the chiasm or Circle of Willis (CW) as risk factors. The aims of this study were to develop a delineation atlas of neurovascular structures, to investigate the doses to these structures in relation to tumor location and to investigate potential dose surrogates for the CW dose. MATERIAL AND METHODS An atlas of the CW, the large intracranial arteries and the suprasellar cistern (SC) was developed and validated. Thirty proton plans from previously treated pediatric brain tumor patients were retrieved and grouped according to tumor site: 10 central, 10 lateralized, and 10 posterior fossa tumors. Based on the atlas, neurovascular structures were delineated and dose metrics (mean dose (Dmean) and maximal dose (Dmax)) to these structures and the already delineated chiasm were evaluated. The agreement between dose metrics to the CW vs. chiasm/SC was investigated. The minimal Hausdorff distance (HDmin) between the target and SC was correlated with the SC Dmean. RESULTS The median Dmean/Dmax to the CW were 53 Gy(RBE)/55 Gy(RBE) in the central tumors, 18 Gy(RBE)/25 Gy(RBE) in the lateralized tumors and 30 Gy(RBE)/49 Gy(RBE) in the posterior fossa tumors. There was a good agreement between the Dmax/Dmean to the CW and the SC for all cases (R2=0.99), while in the posterior fossa group, the CW Dmax was underestimated when using the chiasm as surrogate (R2=0.76). Across all patients, cases with HDmin < 10 mm between the target and the SC received the highest SC Dmean. CONCLUSION The pattern of dose to neurovascular structures varied with the tumor location. For all locations, SC doses could be used as a surrogate for CW doses. A minimal distance larger than 10 mm between the target and the SC indicated a potential for neurovascular dose sparing.
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Affiliation(s)
- L. Toussaint
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - S. Peters
- Department of Particle Therapy, University Hospital Essen, Germany
| | - R. Mikkelsen
- Department of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark
| | - S. Karabegovic
- Department of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark
| | - C. Bäumer
- West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), Germany, German Cancer Consortium (DKTK)
| | - L. P. Muren
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - L. Tram-Henriksen
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - M. Høyer
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Y. Lassen-Ramshad
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - B. Timmermann
- Department of Particle Therapy, University Hospital Essen, Germany
- West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), Germany, German Cancer Consortium (DKTK)
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Rangus I, S Milles L, Galinovic I, Villringer K, J Audebert H, B Fiebach J, H Nolte C, Hebun Erdur. Reclassifications of ischemic stroke patterns due to variants of the Circle of Willis. Int J Stroke 2021; 17:770-776. [PMID: 34569879 PMCID: PMC9358303 DOI: 10.1177/17474930211048381] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Variants of the Circle of Willis (vCoW) may impede correct identification of ischemic lesion patterns and stroke etiology. We assessed reclassifications of ischemic lesion patterns due to vCoW. METHODS We analyzed vCoW in patients with acute ischemic stroke from the 1000+ study using time-of-flight magnetic resonance angiography (TOF MRA) of intracranial arteries. We assessed A1 segment agenesis or hypoplasia in the anterior circulation and fetal posterior cerebral artery in the posterior circulation. Stroke patterns were classified as one or more-than-one territory stroke pattern. We examined associations between vCoW and stroke patterns and the frequency of reclassifications of stroke patterns due to vCoW. RESULTS Of 1000 patients, 991 had evaluable magnetic resonance angiography. At least one vCoW was present in 37.1%. VCoW were more common in the posterior than in the anterior circulation (33.3% vs. 6.7%). Of 238 patients initially thought to have a more-than-one territory stroke pattern, 20 (8.4%) had to be reclassified to a one territory stroke pattern after considering vCoW. All these patients had fetal posterior cerebral artery and six (30%) additionally had carotid artery disease. Of 753 patients initially presumed to have a one-territory stroke pattern, four (0.5%) were reclassified as having more-than-one territory pattern. CONCLUSIONS VCoW are present in about one in three stroke patients and more common in the posterior circulation. Reclassifications of stroke lesion patterns due to vCoW occurred predominantly in the posterior circulation with fetal posterior cerebral artery mimicking multiple territory stroke pattern. Considering vCoW in these cases may uncover symptomatic carotid disease.
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Affiliation(s)
- Ida Rangus
- Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Lennart S Milles
- Department of Neurology, Universitätsklinikum Essen, Essen, Germany
| | | | | | - Heinrich J Audebert
- Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.,Center for Stroke Research Berlin, Berlin, Germany
| | | | - Christian H Nolte
- Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.,Center for Stroke Research Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Hebun Erdur
- Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
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Nyasa C, Mwakikunga A, Tembo L, Dzamalala C, Ihunwo AO. Distribution of variations in anatomy of the circle of Willis: results of a cadaveric study of the Malawian population and review of literature. Pan Afr Med J 2021; 38:11. [PMID: 34567338 PMCID: PMC8444123 DOI: 10.11604/pamj.2021.38.11.27126] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 12/18/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction the circle of Willis is an anatomical structure of clinical importance particularly in the evaluation of neurovascular diseases. Individuals show considerable variations in the anatomical configuration of the circle of Willis. A cross-sectional study was conducted to determine the distribution of morphological variations of the circle of Willis in Malawians and compare with other ethnic groups. Methods brains were collected from twenty-four recently deceased black Malawians during autopsy at Queen Elizabeth Central Hospital, a referral teaching hospital in Blantyre, Malawi and fixed in 10% buffered formalin. Digital images of the interpeduncular region (exposing the circle of Willis) were taken with an 18.4 megapixels camera from the base of the brain. Whole-circle and segmental parameters of the circle of Willis were assessed using the Osiris computer programme and classified based on a 22-type classification scheme. Results the following morphological variations were observed: hypoplasia, aplasia, asymmetry and accessory vessels. Typical circle of Willis was seen in 26% of the cases. Only six of the original twenty-two types were observed. Consistent with most previous studies, types 1, 3, 4, 6, 8 and 9 were common while types 10-22 were rare. Three variants not previously described in the original scheme (unilateral PcoA aplasia, AcoA duplication, and PcoA aplasia with contralateral PcoA hypoplasia) were observed in this study. Conclusion anatomical variations of the circle of Willis in Malawians seem to be distributed in similar frequencies and patterns as in other more-diverse populations. Circle of Willis variants with potential predilection for atherogenesis and aneurysm formation exist in the Malawian population. These should be considered in clinical practice.
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Affiliation(s)
- Charles Nyasa
- Biomedical Sciences Department, Anatomy Division, College of Medicine, University of Malawi, Blantyre, Malawi.,Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Anthony Mwakikunga
- Biomedical Sciences Department, Anatomy Division, College of Medicine, University of Malawi, Blantyre, Malawi.,School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
| | - Lackson Tembo
- Biomedical Sciences Department, Anatomy Division, College of Medicine, University of Malawi, Blantyre, Malawi.,School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
| | - Charles Dzamalala
- Pathology Department, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Amadi Ogonda Ihunwo
- School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
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Mahakul DJ, Agarwal J. Pentagon Inside the Circle of Willis and the Golden Ratio. World Neurosurg 2021; 156:23-26. [PMID: 34508906 DOI: 10.1016/j.wneu.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 11/18/2022]
Abstract
The Golden ratio ("phi" or "Ф") has been known to us for ages and its use in art and architectural designs has enhanced its exquisiteness. Even some of the astounding creations of nature do follow this principle of Golden or divine proportions. Three centuries ago the circle of Willis at the base of the brain was first described and illustrated by Thomas Willis. Classically it was described as being circular in shape, however, the gross anatomy reveals a slightly different picture. The components of this complex neurovascular structure are so arranged that it appears more like a pentagon than a circle. A regular pentagon, unlike a circle, is a Golden shape that mathematically obeys the laws of Golden proportions. Like most other marvelous structures in nature, the close resemblance of the circle of Willis to a pentagon is more of a conscious effort of nature to establish consonance with aesthetic perception, rather than just a mere coincidence.
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Affiliation(s)
- Dibya Jyoti Mahakul
- Department of Neurosurgery, Rajiv Gandhi Cancer Institute and Research, Rohini, New Delhi, India.
| | - Jaya Agarwal
- Department of Gastrointestinal Surgery, Amrita Institute of Medical Sciences, Kochi, India
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Del Brutto OH, Recalde BY, Mera RM. Variants of the Circle of Willis as seen on magnetic resonance angiography and carotid siphon calcifications in community-dwelling older adults. Neuroradiol J 2021; 35:300-305. [PMID: 34464169 DOI: 10.1177/19714009211042890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE Information on the association between anatomical variants of the Circle of Willis (CoW) and intracranial atherosclerotic disease (ICAD) is limited and results are controversial. In this population-based study, we aimed to assess whether an incomplete CoW is associated with high calcium content in carotid siphons (a reliable biomarker of ICAD) in community-dwelling older adults of Amerindian ancestry. METHODS Individuals aged ≥60 years enrolled in the Three Villages Study received a head computed tomography (CT) and magnetic resonance angiogram (MRA) of intracranial vessels. The CoW was classified in complete or incomplete according to the presence or absence of one A1 segment of the anterior cerebral artery or one or both P1 segments of posterior cerebral arteries. Calcium content in carotid siphons was rated as low or high. A multivariate logistic model was fitted to assess the independent association between incompleteness of the CoW and high calcium content in carotid siphons, after adjusting for demographics and cardiovascular risk factors. RESULTS A total of 581 individuals were enrolled (mean age: 71 ± 8.4 years; 57% women). MRA revealed an incomplete CoW in 227 (39%) individuals, and high-resolution CT disclosed high calcium content in carotid siphons in 185 (32%). A risk factor logistic regression model showed no independent association between incompleteness of the CoW and high calcium content in carotid siphons (odds ratio: 0.91; 95% confidence interval: 0.62-1.34; p = 0.631). CONCLUSION Study results disclosed no association between anatomical variants of the CoW and the presence of high calcium content in carotid siphons.
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Zhao Y, Shu N, Liu Q, Jiang H. "Hands" teaching method in Circle of Willis: A useful model. Asian J Surg 2021:S1015-9584(21)00436-X. [PMID: 34334247 DOI: 10.1016/j.asjsur.2021.06.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 06/22/2021] [Indexed: 11/22/2022] Open
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Zimelewicz Oberman D, Perez Akly MS, Rabelo NN, Elizondo C, Amorim Correa JL, Ajler P, Baccanelli MM. Morphologic Variations in the Circle of Willis as a Risk Factor for Aneurysm Rupture in the Anterior and Posterior Communicating Arteries. World Neurosurg 2021; 154:e155-e162. [PMID: 34273549 DOI: 10.1016/j.wneu.2021.06.151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Intracranial aneurysms are acquired abnormal vascular dilations. The most dangerous complication of a cerebral aneurysm is its rupture, with a high rate of mortality. This study aimed to determine whether there is an association between anatomic variations in the circle of Willis and ruptured aneurysms in the anterior and posterior communicating arteries. METHODS A cross-sectional study of adult patients with a diagnosis of intracranial aneurysm was carried out between March 2015 and March 2019. The patients were divided into groups of ruptured or unruptured aneurysm in the anterior and posterior communicating arteries. RESULTS A total of 132 patients with anterior and posterior communicating artery aneurysms were included. The presence of anatomic variation in the circle of Willis presented a statistically significant association with ruptured aneurysms (odds ratio [OR], 2.28; 95% confidence interval [CI], 1.11-4.65; P = 0.024). There was a statistically significant difference between the presence of nonspherical aneurysm and rupture (OR, 6.9; 95% CI, 3.12-15.48; P < 0.0001). Multivariate logistic regression observed smoking (OR, 2.4; 95% CI, 1.01-5.9; P = 0.4), anterior complex variations (OR, 2.68; 95% CI, 1.01-7.18; P < 0.04), and nonspherical morphology (OR, 4.7; 95% CI, 1.93-11.45; P = 0.001) presented a statistically significant association with the rupture. CONCLUSIONS Our results suggest that the studied variations of the circle of Willis and nonspherical morphology, in addition to playing a role in the development of cerebral aneurysms, may contribute to their rupture.
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Affiliation(s)
| | | | | | - Cristina Elizondo
- Department of Internal Medicine Research Area, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Pablo Ajler
- Department of Neurosurgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Liu Y, Zhu L, Hou B, Wang T, Xu D, Tan C, Zhang H, Li C, Wang J. Study on the correlation between the circle of Willis structure and collateral circulation in bilateral carotid artery occlusion. Neurol Sci 2021. [PMID: 33893567 DOI: 10.1007/s10072-021-05265-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/16/2021] [Indexed: 11/04/2022]
Abstract
Background and purpose Bilateral carotid artery occlusion (CAO) is a rare condition and the collateral circulation is more complicated than in unilateral CAO. The circle of Willis (CoW) is the most important collateral circulation compensation pathway in CAO. However, the specific role of CoW in the collateral circulation compensation pathway of CAO has not been fully elucidated. The purpose of this study is to investigate the role of CoW in the collateral circulation compensation pathway of CAO. Materials and methods Clinical, imaging, and hemodynamic data of 30 patients with bilateral CAO were collected to analyze the collateral blood flow compensation pathway and its characteristics, and to examine the correlation between the structure of the CoW and the collateral circulation of bilateral CAO. Results This paper summarized 30 patients with bilateral CAO. There were 0 cases of the CoW complete type, 18 cases of the partially complete type (60%), and 12 cases of the incomplete type (40%). For the partially complete type cases, there were 14 complete anterior circulation cases (46.7%). The collateral circulation collateral circulation pathway included 14 cases with anterior communicating artery(ACoA), 7 cases with posterior cerebral artery (PCA)-middle cerebral artery (MCA) leptomeningeal anastomosis (LMA), 5 cases with ophthalmic artery(OA), 3 cases with lateral posterior communicating artery(PCoA), 1 case with internal carotid artery (ICA) stealing, 1 case with new Moyamoya vessels, and 4 cases of other types. There were four cases (13.3%) with complete posterior circulation, including four cases with bilateral PCoA, three cases with PCA-MCA LMA, and two cases with OA. There were 12 cases (40%) with incomplete CoW, including 8 cases with PCA-MCA LMA, 3 cases with lateral PCoA, 1 case with anterior cerebral artery (ACA)-MCA LMA, 4 cases with OA, and 1 other case. Conclusion The collateral circulation pathway differs among patients with different CoW structure types. When the CoW is partially complete, it mainly provides blood flow compensation to the ischemic area through primary collateral circulation. When the CoW is incomplete, it mainly provides blood flow compensation to the ischemic area through secondary collateral circulation.
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De Caro J, Ciacciarelli A, Tessitore A, Buonomo O, Calzoni A, Francalanza I, Dell'Aera C, Cosenza D, Currò CT, Granata F, Vinci SL, Trimarchi G, Toscano A, Musolino RF, La Spina P. Variants of the circle of Willis in ischemic stroke patients. J Neurol 2021. [PMID: 33786665 DOI: 10.1007/s00415-021-10454-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/08/2021] [Accepted: 02/08/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE We aim to provide prevalence and pattern of anatomical variants of circle of Willis in over one thousand ischemic stroke patients compared to an age- and sex-matched control group, and to determine their role in the severity and in-hospital prognosis. METHODS Two groups of neuroradiologists evaluated all vascular images of ischemic stroke patients and controls to identify anatomical variants using a preexisted classification. We collected data concerning patient characteristics, stroke severity on admission and discharge, in-hospital mortality, hemorrhagic transformation, acute treatment performed, and etiology. RESULTS We included 1131 patients with acute ischemic stroke and 562 controls. Among stroke patients, 702 (62.1%) had one or more vascular variants, compared to 308 (54.8%) of the control group (p < 0.01), 165/702 (23.5%) had an anterior circulation variant only, 384/702 (54.7%) had a posterior circulation variant only, and 153/702 (21.8%) patients had variants in both anterior and posterior circulation. Patients with variants were older (69.7 ± 13.9 years vs 72.0 ± 12.9 years; p = 0.039). The most prevalent variant was the agenesis/hypoplasia of the ACA (201/1131; 17.8%) followed by the unilateral fetal type of the PCA (137/1131; 12.11%). CONCLUSIONS We provided the prevalence and the pattern of the brain vascular variants of the circle of Willis in a cohort of patients with ischemic stroke. The prevalence of variants was higher in stroke patients compared to controls. Patients with variants were older but had no differences in sex, neurological admission severity, hemorrhagic transformation, etiology, and in-hospital outcome compared to patients with a typical circle of Willis.
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