CTA Characteristics of the Circle of Willis and Intracranial Aneurysm in a Chinese Crowd with Family History of Stroke

Abstract

Background and Purpose. The vascular morphology in crowd with family history of stroke remains unclear. The present study clarified the characteristics of the intracranial vascular CoW and prevalence of intracranial aneurysms in subjects with family history of stroke. Methods. A stratified cluster, random sampling method was used for subjects with family history of stroke among rural residents in Jixian, Tianjin, China. All the subjects underwent a physical examination, head computed tomography (CT) scan, and cephalic and cervical computed tomography angiography (CTA) scan. Anatomic variations in the Circle of Willis and cerebrovascular disease in this population were analyzed. Results. In the crowd with similar living environment, stable genetic background, and family history of stroke and without obvious nerve function impairment (1) hypoplasia or absence of A1 segment was significantly different in gender (male versus female: 9.8% versus 18.8%, p = 0.031), especially the right-side A1 (male versus female: 5.9% versus 16.4%, p = 0.004). (2) Hypoplasia or absence of bilateral posterior communicating arteries was more common in men than women (58.2% versus 45.3%, p = 0.032). Unilateral fetal posterior cerebral artery was observed more often in women than men (17.2% versus 8.5%, p = 0.028). (3) The percentage of subjects with incomplete CoW did not increase significantly with age. Compared to healthy Chinese people, the crowd had a higher percentage of incomplete CoW (p < 0.001). (4) No obvious correlation between risk factors and CoW was found. (5) The prevalence of aneurysm was 10.3% in the special crowd. Conclusions. The certain variations of CoW showed significant relation to gender, but not to age in people with family history of stroke. The incomplete circle may be a dangerous factor that is independent of common risk factors for stroke and tend to lead to cerebral ischemia in the crowd with family history of stroke. The prevalence of intracranial aneurysm is comparatively high in the present subjects compared to other people.

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

“…[29] In this study, younger patient age was highly predictive of CoW completeness, a relationship becoming increasingly well established in literature. [21,32,[37][38][39] The results of this study strengthen this association, finding age to be an independent predictor of complete CoW, even after controlling for hypertension and diabetes mellitus.…”

“…The two other demographic variables assessed (gender and race) showed no significant difference in CoW completeness. Previous studies have found a higher female preponderance; [32,34,38] however, others [39,53] have reported opposite findings, with men having a slightly higher completeness. Racial and ethnic differences in configuration have been a recent research focus, in which a Sri Lankan autopsy study [46] demonstrated that CoW configuration varied among ethnicity.…”

“…CoW completeness has varied considerably in imaging [31][32][33][34][35][36][37][38][39][40][41][42] and autopsy [6,[43][44][45][46][47][48][49][50] studies. The completeness rate in this study replicates a recent large sample study with a similar focus using CTA.…”

Are the Variants of the Circle of Willis Determined by Genetic or Environmental Factors? Results of a Twin Study and Review of the Literature

“…A recent animal study showed that chronically elevated blood pressure and aging decreased PCoA diameter in inbred mice, but obesity, hyperlipidemia, metabolic syndrome, and diabetes mellitus did not affect this arterial diameter (Faber et al, 2018). Jin et al (2016) found that incomplete posterior circulation was present in subjects without hypertension more commonly than in those with hypertension. Although we did not investigate gender differences in CW variants, Zaninovich et al (2017) found that complete CW differed significantly between men and women above the age of 39 years, suggesting that age combined with other environmental factors may have a significant impact.…”

Association between Circle of Willis Configuration and Rupture of Cerebral Aneurysms

“…If we observe the point of separation of PCoA in relation to ICA, as a point of bifurcation angle, then we can apply the principle of the optimal distribution of flow for the given angle [10]. Any increase in this angle leads to a direct increase in stress on the site of separation of PcoA, so that the formation of an aneurysm on PcoA is due to the geometry itself and the course the ICA takes in thatpart of PcoA [20,21].…”