Anatomical variations of the circle of Willis and cerebrovascular accidents in transitional Albania

Abstract

Aim: The purpose of this study was twofold: i) in a case-control design, to determine the relationship between anatomical variations of the circle of Willis and cerebrovascular accidents; ii) to assess the association between anatomical variations of the circle of Willis and aneurisms among patients with subarachnoid hemorrhage.
 Methods: A case-control study was conducted in Albania in 2013-2014, including 100 patients with subarachnoid hemorrhage and 100 controls (individuals without cerebrovascular accidents). Patients with subarachnoid hemorrhage underwent a CT angiography procedure, whereas individuals in the control group underwent a magnetic resonance angiography procedure. Binary logistic regression was used to assess the association between cerebrovascular accidents and the anatomical variations of the circle of Willis. Conversely, Fisher’s exact test was used to compare the prevalence of aneurisms between subarachnoid hemorrhage patients with and without anatomical variations of the circle of Willis.
 Results: Among patients, there were 22 (22%) cases with anatomical variations of the circle of Willis compared with 10 (10%) individuals in the control group (P=0.033). There was no evidence of a statistically significant difference in the types of the anatomical variations of the circle of Willis between patients and controls (P=0.402). In age- and-sex adjusted logistic regression models, there was evidence of a significant positive association between cerebrovascular accidents and the anatomical variations of the circle of Willis (OR=1.87, 95%CI=1.03-4.68, P=0.048). Within the patients’ group, of the 52 cases with aneurisms, there were 22 (42.3%) individuals with anatomical variations of the circle of Willis compared with no individuals with anatomical variations among the 48 patients without aneurisms (P<0.001).
 Conclusion: This study provides useful evidence on the association between anatomical variations of the circle of Willis and cerebrovascular accidents in transitional Albania. Furthermore, findings from this study confirm the role of the anatomical variations of the circle of Willis in the occurrence of cerebral aneurisms.