Effects of Circle of Willis Anatomic Variations on Angiographic and Clinical Outcomes of Coiled Anterior Communicating Artery Aneurysms

Tarulli, Emidio; Sneade, Mary; Clarke, A. M.; Molyneux, Andy; Fox, Allan J.

doi:10.3174/ajnr.a3991

Cited by 28 publications

(37 citation statements)

References 20 publications

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“…Underdevelopment of the circle of Willis, which leads to its anatomical variations, can also contribute to weakening of its arteries [18]. It remains significant field of study, with newer research highlighting influence of circle of Willis variations on results of aneurysms treatment [20]. Our results of circle of Willis variations are similar to earlier studies [10].…”

Section: Mca Aneurysmssupporting

confidence: 82%

Middle cerebral artery anatomical variations and aneurysms: a retrospective study based on computed tomography angiography findings

et al. 2018

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Section: Mca Aneurysmssupporting

confidence: 82%

Middle cerebral artery anatomical variations and aneurysms: a retrospective study based on computed tomography angiography findings

et al. 2018

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“…In a study on the effects of circle of Willis anatomic variations on angiographic and clinical outcomes of coiled ACOM artery aneurysms, Tarulli et al 13 demonstrated a statistically significant increase in neck remnants and progressive aneurysm sac filling with the A1 dominant configuration, suggesting that this anatomical-hemodynamic feature contributes to aneurysm formation, growth, and instability after coiling treatment. Another study evaluating morphological features of ACOM region aneurysms demonstrated that, among the features studied (direction of the dome, dome size, dome to neck ratio, presence of irregularity, and angle between A1 segment of the anterior cerebral artery and the internal carotid artery), only superior dome direction was associated with incomplete occlusion 10.…”

Section: Discussionmentioning

confidence: 99%

Treatment of complex anterior cerebral artery aneurysms with Pipeline flow diversion: mid-term results

Dabus

Grossberg

Cawley

et al. 2016

J NeuroIntervent Surg

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BACKGROUND: The off-label use of flow diverters in the treatment of distal aneurysms continues to be debated. OBJECTIVE: To report our multicenter experience in the treatment of complex anterior cerebral artery aneurysms with the Pipeline embolization device (PED). METHODS: The neurointerventional databases of the four participating institutions were retrospectively reviewed for aneurysms treated with PED between October 2011 and January of 2016. All patients treated for anterior cerebral artery aneurysms were included in the analysis. Clinical presentation, location, type, vessel size, procedural complications, clinical and imaging follow-up were included in the analysis. RESULTS: Twenty patients (13 female) with 20 aneurysms met the inclusion criteria in our study. Fifteen aneurysms were classified as saccular and five as fusiform (mean size 7.3 mm). Thirteen aneurysms were located in the anterior communicating region (ACOM or A1/2 junction), six were A2-pericallosal, and one was located in the A1 segment. Six patients had presented previously with subarachnoid hemorrhage and had their aneurysms initially clipped or coiled. There was one minor event (a small caudate infarct) and one major event (intraparenchymal hemorrhage). Sixteen of the 20 patients had angiographic follow-up (mean 10 months). Eleven aneurysms were completely occluded, one had residual neck, and four had residual aneurysm filling. CONCLUSIONS: The treatment of complex anterior cerebral artery aneurysms with the PED as an alternative for patients who are not good candidates for conventional methods is technically feasible and safe. Mid-term results are promising but larger series with long-term follow-up are required to assess its effectiveness

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“…Any variation in morphology of CoW alters the occurrence and severity of cerebrovascular disorders, treatment options and recovery. [2][3][4][5][6][7][8] The problem of stroke in India is significantly different from Western World in terms of epidemiology, patterns and presentation. Hence, data from Western literature is not applicable.…”

Section: Introductionmentioning

confidence: 99%

Variations of Circle of Willis in Indian Population

Rathod

Joish²

2018

AJMRR

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Background: Circle of Willis(CoW) provides the crucial anastomotic vascular supply to brain, Variations of Circle of Willis are associated with high incidence of Cerebrovascular accidents. Scant data exists in Indian context on the CoW variations prevalent. Aims: To find the frequency of variations of CoW in Indian population and review literature on stroke epidemiology. Settings and Design: Prospective observational study in a tertiary care hospital. Subjects and Methods: A study was undertaken between January 2017 and February 2018. Apparently healthy individuals underwent 3 dimensional Time of Flight MR angiography (3D TOF MRA) imaging of circle of Willis. Anatomy of circle of Willis was evaluated on the Image volume dataset and MIP reformations. Percentage of variations of CoW was calculated and compared with the existing data. Review of literature on epidemiology and pathophysiology of stroke in India was done. Statistical analysis used: Percentage of variations of CoW calculated. Results: The study included 197 volunteers with a mean age of 33 years and 5 months, who underwent 3D TOF MRA. Complete and balanced CoW was seen in 37.1% of them. Posterior circulation variations were found in 58.3% and anterior circulation variations in 20.3%. Hypoplastic/aplastic Posterior communicating arteries were the commonest segmental variations. No immediate or direct correlation was found between results obtained and epidemiology of stroke in India. Conclusion: Variations are the rule in CoW and are more often seen in posterior circulation. Increased prevalence rates of particular variations are likely to be associated with certain patterns of cerebrovascular disease.

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Effects of Circle of Willis Anatomic Variations on Angiographic and Clinical Outcomes of Coiled Anterior Communicating Artery Aneurysms

Cited by 28 publications

References 20 publications

Middle cerebral artery anatomical variations and aneurysms: a retrospective study based on computed tomography angiography findings

Middle cerebral artery anatomical variations and aneurysms: a retrospective study based on computed tomography angiography findings

Treatment of complex anterior cerebral artery aneurysms with Pipeline flow diversion: mid-term results

Variations of Circle of Willis in Indian Population

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