Influence of the circle of Willis on leptomeningeal collateral flow in anterior circulation occlusive stroke: Friend or foe?

Millesi, Katharina; Mutzenbach, Johannes Sebastian; Killer‐Oberpfalzer, Monika; Hecker, Constantin; Machegger, Lukas; Bubel, Nele; Ramesmayer, Christian; Pikija, Slaven

doi:10.1016/j.jns.2018.11.002

Cited by 11 publications

(5 citation statements)

References 30 publications

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“…However, there was no detailed discussion of the CoW in this article or in a more recent review on the topic of collateral circulation in the setting of thrombectomy (27,28). One article described the importance of Acom and Pcom to the existence of LA collaterals (29). A similar scenario may occur during the performance of carotid endarterectomy in the setting of contralateral ICA occlusion.…”

Section: Simulation Of Catheter Movementmentioning

confidence: 93%

Computer Modeling of Clot Retrieval—Circle of Willis

Phan

Goyal

et al. 2020

Front. Neurol.

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Endovascular clot retrieval, often referred to as mechanical thrombectomy, has transformed the treatment of patients with ischemic stroke based on an underlying large cerebral vessel occlusion, ranging from the extracranial internal carotid artery (ICA) to the M1 (proximal) segment of the middle cerebral artery (MCA). The aim of this study was to evaluate the effect of a progressive occlusion of the extracranial portion of the ICA on the cerebral blood flow either with a conventional guiding catheter or a balloon-guiding catheter, which enables the operator to completely occlude the parent artery by inflating the balloon around the tip of this type of guiding catheter. We evaluated the impact of flow reduction in the ICA in the setting of ipsilateral MCA occlusion given the different configurations of the circle of Willis (CoW). The computer model of cerebral arteries was based on anatomical works by Rhoton (1) and van der Eecken (2). The interactive experimental results are available on the web at https://gntem3.shinyapps. io/ecrsim. In the setting of left MCA occlusion, compensation from the anterior and posterior communicating artery preserved the flow in the left anterior cerebral artery (ACA) but not the left MCA branches. Under selected CoW configurations, such as classic, missing Acom, or missing A1 segment of the ACA and concurrent right ICA occlusion, there was a progressive decrease of flow in the left ACA to a minimum of 78% when the simulated catheter fully occluded the left ICA. Flow collapsed (<10%) in the left ACA and MCA branches under CoW configurations, such as bilateral fetal PCA. In summary, compensatory flow collapsed under certain clot retrieval scenarios and unusual configurations of CoW.

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Section: Simulation Of Catheter Movementmentioning

confidence: 93%

Computer Modeling of Clot Retrieval—Circle of Willis

Phan

Goyal

et al. 2020

Front. Neurol.

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“…Figure 5(a) (j to l) show red water flow directed right to left sequentially. Cross flow 24,28 that observed in Figure 5(a) (c) is important phenomenon which is not seen before obviously.…”

Section: Resultsmentioning

confidence: 54%

“…a) (j to l) show red water flow directed right to left sequentially. Cross flow24,28 that observed in Figure5(a) (c) is important phenomenon which is not seen before obviously.Figure6(a) (a to l) display blood flow at ACoA and L.ACA intersection as a common site for variation in CoW29,30 at the circumstances that pressure drop occurred at L.MCA and R.MCA. Color min value distribution of Figure6(a) (a, f, and k) is displayed in Figure 6(b).…”

mentioning

confidence: 58%

Collateral flow at circle of Willis in healthy condition

Abdi

Navidbakhsh

2021

Perfusion

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Experimental simulation of cerebrovascular system would be very beneficial tool to evaluate millions of human body cascade sequence. The Circle of Willis (CoW) recently named Cerebral Arterial Circle (CAC) is a main loop structure of cerebral circulatory system which positioned at the cranium base. In this research, we investigate cerebral artery flow pattern in cerebral arteries including afferent, Willisian, and efferent arteries of CAC emphasizing on communicating and connecting arteries which are main routes in CAC and as a risky sites when autoregulation is occurred in terminal parts of middle cerebral arteries (MCAs) by PMMA (Polymethyl methacrylate) chip and high quality camera which depict Sequential images. This novelty study analyze flow pattern in CAC that have been challenging subject area for many years which have investigated by scientists yet, because flow pattern in CAC indicate complication progression. This research tries to construct new platform in cerebral circulation analyzing method by reliable experimental in-vitro approach. The outcomes of this study demonstrate that communicating arteries especially anterior communicating artery (ACoA) is main artery in CAC flow distribution.

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“…The CoW is often investigated in patients with atherosclerotic disease or ischemic stroke [ 12 , 16 , 17 , 25 ], but little attention has been given to patients with ICH in the literature. Our present study in consecutive ICH patients finds that in patients aged < 60 years, poor CoW was associated with a higher incidence of HA-ICH, and a lower incidence of mixed ICH, although the significant associations were not independent.…”

Section: Discussionmentioning

confidence: 99%

“…The median time from onset to MRA/CTA was 1.8 (0.5–8.9) days. The presence, diameter, and length of all component vessels of the CoW were evaluated on the source images of 3D time-of-flight and maximum intensity projection images of MRA [ 9 , 15 ] or source data of CTA [ 16 ]. Any vessel that was at least 0.8 mm in diameter was considered as present [ 15 ].…”

Section: Methodsmentioning

confidence: 99%

Circle of Willis Morphology in Primary Intracerebral Hemorrhage

Cheng

et al. 2022

Transl. Stroke Res.

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We aimed to study the distribution of Circle of Willis (CoW) morphology and its association with intracerebral hemorrhage (ICH) etiology and cerebral small vessel disease (CSVD) burden. Patients with primary ICH who had brain MRIs were consecutively enrolled between March 2012 and January 2021. CoW morphology, CSVD features and the combined CSVD burden (including global CSVD burden, total hypertensive arteriopathy [HA] burden, and total cerebral amyloid angiopathy [CAA] burden) were assessed. CoW morphology included poor CoW (defined as CoW score 0–2), incomplete CoW, and complete fetal-variant of the posterior communicating artery (CFPcoA). Among 296 patients enrolled, 215 were included in the analysis. There was no significant difference among HA-, CAA-, and mixed-ICH in each CoW morphology. Exploratory subgroup analyses suggested that poor CoW was associated with a greater incidence of HA-ICH and low incidence of mixed ICH in patients aged < 60 years, while mixed ICH occurred more frequently in patients with CFPcoA, especially in those without hypertension history (all p < 0.050). Additionally, incomplete CoW was correlated with a larger incidence of lacunes (adjusted OR [adOR] 2.114, 95% CI 1.062–4.207), microbleeds ≥ 5 (adOR 2.437, 95% CI 1.187–5.002), and therefore the combined CSVD burden (adOR 1.194, 95% CI 1.004–1.419 for global CSVD burden, adOR 1.343, 95% CI 1.056–1.707 for total CAA burden), independent of modifiable vascular risk factors, but not age and sex. The CoW might therefore have a potential impact on ICH etiology and is associated with a greater CSVD burden. Our findings are novel, and need to be verified in future studies.

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Influence of the circle of Willis on leptomeningeal collateral flow in anterior circulation occlusive stroke: Friend or foe?

Cited by 11 publications

References 30 publications

Computer Modeling of Clot Retrieval—Circle of Willis

Computer Modeling of Clot Retrieval—Circle of Willis

Collateral flow at circle of Willis in healthy condition

Circle of Willis Morphology in Primary Intracerebral Hemorrhage

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