Completion of the Circle of Willis Varies by Gender, Age, and Indication for Computed Tomography Angiography

Zaninovich, Orel A.; Ramey, Wyatt L.; Walter, C.; Dumont, Travis M.

doi:10.1016/j.wneu.2017.07.084

Cited by 42 publications

(37 citation statements)

References 52 publications

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“…[5,[12][13][14][15][16][17][18] Individuals with good cerebral collateral circulation tend to have smaller infarct size at baseline and higher rates of neurological improvement following acute ischemic stroke. [19,20] A recent work by Zaninovich et al [21] supports the emerging theory that age and gender have a significant effect on the rates of complete CoW, which subsequently impacts these disease states. Women have a higher lifetime risk of stroke, more frequent recurrences, and higher mortality, whereas men have the risk of first stroke at a younger age.…”

Section: Introductionmentioning

confidence: 82%

“…The completeness rate in this study replicates a recent large sample study with a similar focus using CTA. [21] The functional assessment afforded by DSA allows for accurate characterization of small-diameter vessels into aplastic versus hypoplastic. This nuanced evaluation of hypoplastic vessels altered the completion frequency considerably when hypoplastic vessels were considered incomplete.…”

Section: Discussionmentioning

confidence: 99%

“…To minimize differences between prior studies on CoW configuration, the major branches of the CoW were considered to be the anterior communicating artery, the first segments of both anterior cerebral arteries, the first segments of both posterior cerebral arteries, and both posterior communicating arteries. [21,25] Each segment was graded as normal, hypoplastic, or aplastic [ Figure 1]. Hypoplastic was defined as vessel size <30% of the size of the ipsilateral distal vessel.…”

Section: Image Analysismentioning

confidence: 99%

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Demographic age-related variation in Circle of Willis completeness assessed by digital subtraction angiography

et al. 2020

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Incomplete circle of Willis (CoW) configuration is an important risk factor for cerebrovascular pathology, namely aneurysm formation and ischemic stroke. This study was performed to characterize CoW variation using digital subtraction angiography and to identify demographic and physiologic features that may influence the risk of having an incomplete CoW configuration. MATERIALS AND METHODS: A retrospective review of 274 patients who underwent cerebral angiography by a single surgeon for any indication was conducted. Each CoW branch was graded as normal, hypoplastic, or aplastic. Univariate and multivariate regression analyses were conducted to assess the impact of age, gender, race, and certain comorbidities on CoW configuration. RESULTS: A complete CoW was identified in 37.23% of patients. In univariate analysis, patients <40 years old were more likely to have a complete CoW (odds ratio [OR]: 4.973, 95% confidence interval [CI]: 2.610-9.476, P < 0.001) as were patients <70 years old (OR: 2.849, 95% CI: 1.131-7.194, P < 0.05). Univariate analysis on demographic factors and comorbidities revealed CoW completeness to decrease with hypertension (OR: 0.575, 95% CI: 0.347-0.951, P = 0.031) and diabetes mellitus (OR: 0.368, 95% CI: 0.180-0.754, P = 0.006). Multivariable logistic regression analysis used to assess the impact of age on CoW completeness showed age to be an independent predictor of complete CoW, with an inverse correlation between increasing age and CoW completeness (OR: 0.955, 95% CI: 0.937-0.973, P < 0.001) after controlling for potential confounders including hypertension and diabetes mellitus. CONCLUSIONS: CoW configuration shows considerable variation with age; however, further investigation is required to elucidate the full impact of other demographic and vascular risk factors on CoW anatomy.

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Section: Introductionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Image Analysismentioning

confidence: 99%

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Demographic age-related variation in Circle of Willis completeness assessed by digital subtraction angiography

et al. 2020

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“…Anatomical variations of the CoW are common in the general population. CoW variants may be congenital but can also be acquired when patients get older (Zaninovich, Ramey, Walter, & Dumont, 2017). Some (Bugnicourt et al, 2009;Cavestro et al, 2011;Cucchiara et al, 2013;Henry et al, 2015), but not all (Schoonman, van Oosterhout, Ferrari, & van der Grond, 2010;Ezzatian-Ahar et al, 2014;Ikeda et al, 2017), studies report a higher frequency of incomplete CoW in migraine patients compared with controls in particular for the posterior circulation and in patients with migraine with aura.…”

Section: Introductionmentioning

confidence: 99%

Circle of Willis variations in migraine patients with ischemic stroke

et al. 2019

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Objectives Migraine is a risk factor for stroke, which might be explained by a higher prevalence in anatomical variants in the circle of Willis (CoW). Here, we compared the presence of CoW variants in patients with stroke with and without migraine. Materials and Methods Participants were recruited from the prospective Dutch acute Stroke Study. All participants underwent CT angiography on admission. Lifetime migraine history was assessed with a screening questionnaire and confirmed by an interview based on International Classification of Headache Disorders criteria. The CoW was assessed for incompleteness/hypoplasia (any segment <1 mm), for anterior cerebral artery asymmetry (difference > 1/3), and for posterior communicating artery (Pcom) dominance (Pcom–P1 difference > 1/3). Odds ratios with adjustments for age and sex ( aOR ) were calculated with logistic regression. Results We included 646 participants with stroke, of whom 52 had a history of migraine. Of these, 45 (87%) had an incomplete or hypoplastic CoW versus 506 (85%) of the 594 participants without migraine ( aOR : 1.47; 95% CI : 0.63–3.44). There were no differences between participants with and without migraine in variations of the anterior or posterior CoW, anterior cerebral artery asymmetry ( aOR : 0.86; 95% CI : 0.43–1.74), or Pcom dominance ( aOR : 0.64; 95% CI : 0.32–1.30). There were no differences in CoW variations between migraine patients with or without aura. Conclusion We found no significant difference in the completeness of the CoW in acute stroke patients with migraine compared to those without.

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“…Sex differences were seen for IS as females had higher incidence and longer life expectancy but worse functional outcomes [3,4], which might be due to different risk factors [5,6,7], anatomic structural Willis incompletion or white integrity [8,9], biologically inherent sex chromosome complemented with gonadal hormones [10,11,12], socialized reasons of in-hospital care [6,13], and therefore, pathology and treatment [14,15]. However, animal-based research has observed decreased infarct size and improved outcomes in female compared to males [16].…”

Section: Introductionmentioning

confidence: 99%

Sex-specific and opposite modulatory aspects revealed by PPI network and pathway analysis of ischemic stroke in humans

et al. 2020

PLoS ONE

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BackgroundIschemic Stroke (IS) is a major disease which greatly threatens human health. Recent studies showed sex-specific outcomes and mechanisms of cerebral ischemic stroke. This study aimed to identify the key changes of gene expression between male and female IS in humans. MethodsGene expression dataset GSE22255, including peripheral blood samples, was downloaded from the Gene Expression Omnibus (GEO) dataset. Differentially Expressed Genes (DEGs) with a LogFC>1, and a P-value <0.05 were screened by BioConductor R package and grouped in female, male and overlap DEGs for further bioinformatic analysis. Gene Ontology (GO) functional annotation, Protein-Protein Interaction (PPI) network, "Molecular Complex Detection" (MCODE) modules, CytoNCA (cytoscape network centrality analysis) essential genes and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway interrelation analysis were performed. ResultsIn a total of 54,665 genes, 185 (73 ups and 112 downs) DEGs in the female dataset, 461 DEGs (297 ups and 164 downs) in the male dataset, within which 118 DEGs overlapped (7 similar changes in female and male, 111 opposite changes in female and male) were obtained from the GSE22255 dataset. Female, male and overlapping DEGs enriched for similar cellular components and molecular function. Male DEGs enriched for divergent biological processes from female and overlapping DEGs. Sex-specific and overlapping DEGs were put into the PPI network. Overlapping genes such as IL6, presented opposite changes and were mainly involved in cytokine-cytokine receptor interactions, the TNF-signalling pathway, etc.

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Completion of the Circle of Willis Varies by Gender, Age, and Indication for Computed Tomography Angiography

Cited by 42 publications

References 52 publications

Demographic age-related variation in Circle of Willis completeness assessed by digital subtraction angiography

Demographic age-related variation in Circle of Willis completeness assessed by digital subtraction angiography

Circle of Willis variations in migraine patients with ischemic stroke

Sex-specific and opposite modulatory aspects revealed by PPI network and pathway analysis of ischemic stroke in humans

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