Orel A Zaninovich1, Wyatt L Ramey2, Christina M Walter2, Travis M Dumont3. 1. University of Arizona College of Medicine, Tucson, Arizona, USA. 2. Division of Neurosurgery, Banner University Medical Center, Tucson, Arizona, USA. 3. Division of Neurosurgery, Banner University Medical Center, Tucson, Arizona, USA. Electronic address: tdumont@surgery.arizona.edu.
Abstract
OBJECTIVE: The circle of Willis (CoW) is the foremost anastomosis and blood distribution center of the brain. Its effectiveness depends on its completion and the size and patency of its vessels. Gender-related and age-related anatomic variations in the CoW may play an important role in the pathogenesis of cerebrovascular diseases. In this study, we analyzed computed tomography angiograms (CTAs) to assess for differences in CoW completion related to gender, age, and indication for CTA. METHODS: A total of 834 CTAs were retrospectively analyzed for all CoW vessels to compare the incidence of complete CoW and variation frequency based on gender, age, and indication. RESULTS: The incidence of complete CoW was 37.1% overall. CoW completion showed a statistically significant decrease with increasing age for all age groups in both men (47.0%, 29.4%, 18.8%) and women (59.1%, 44.2%, 30.9%). Completion was greater in women (43.8%) than in men (31.2%) overall and for all age groups. These gender differences were all statistically significant except for the 18-39 years age group. The most frequent of the 28 CoW variations were absent posterior communicating artery (PCOM) bilaterally (17.1%), right PCOM (15.3%), and left PCOM (10.9%). Ischemic stroke and the 18-39 years age group of hemorrhagic stroke showed a statistically significant reduction in completion relative to trauma. CONCLUSIONS: The incidence of complete CoW is likely greater in women for all age groups and likely decreases with age in both genders. The most frequently absent vessel is likely the PCOM, either unilaterally or bilaterally. Completion may play a role in ischemic stroke and a subset of patients with hemorrhagic stroke.
OBJECTIVE: The circle of Willis (CoW) is the foremost anastomosis and blood distribution center of the brain. Its effectiveness depends on its completion and the size and patency of its vessels. Gender-related and age-related anatomic variations in the CoW may play an important role in the pathogenesis of cerebrovascular diseases. In this study, we analyzed computed tomography angiograms (CTAs) to assess for differences in CoW completion related to gender, age, and indication for CTA. METHODS: A total of 834 CTAs were retrospectively analyzed for all CoW vessels to compare the incidence of complete CoW and variation frequency based on gender, age, and indication. RESULTS: The incidence of complete CoW was 37.1% overall. CoW completion showed a statistically significant decrease with increasing age for all age groups in both men (47.0%, 29.4%, 18.8%) and women (59.1%, 44.2%, 30.9%). Completion was greater in women (43.8%) than in men (31.2%) overall and for all age groups. These gender differences were all statistically significant except for the 18-39 years age group. The most frequent of the 28 CoW variations were absent posterior communicating artery (PCOM) bilaterally (17.1%), right PCOM (15.3%), and left PCOM (10.9%). Ischemic stroke and the 18-39 years age group of hemorrhagic stroke showed a statistically significant reduction in completion relative to trauma. CONCLUSIONS: The incidence of complete CoW is likely greater in women for all age groups and likely decreases with age in both genders. The most frequently absent vessel is likely the PCOM, either unilaterally or bilaterally. Completion may play a role in ischemic stroke and a subset of patients with hemorrhagic stroke.
Authors: Andrea M Herrmann; Stephan Meckel; Matthew J Gounis; Leona Kringe; Edith Motschall; Christoph Mülling; Johannes Boltze Journal: J Cereb Blood Flow Metab Date: 2019-02-07 Impact factor: 6.200
Authors: Tavishi Chopra; Ilana Neuberger; Eric Prince; Christina White; John Maloney; Nicholas Stence; David Mirsky Journal: Childs Nerv Syst Date: 2022-04-08 Impact factor: 1.532
Authors: James E Faber; Hua Zhang; Wojciech Rzechorzek; Kathy Z Dai; Benjamin T Summers; Cooper Blazek; Samuel J Hedges Journal: Transl Stroke Res Date: 2018-03-27 Impact factor: 6.829
Authors: Arend M Hamming; Marianne A A van Walderveen; Inge A Mulder; Irene C van der Schaaf; L Jaap Kappelle; Birgitta K Velthuis; Michel D Ferrari; Gisela M Terwindt; Marieke C Visser; Wouter Schonewille; Ale Algra; Marieke J H Wermer Journal: Brain Behav Date: 2019-02-16 Impact factor: 2.708
Authors: Whitney C McFadden; Hadley Walsh; Felix Richter; Céline Soudant; Clare H Bryce; Patrick R Hof; Mary Fowkes; John F Crary; Andrew T McKenzie Journal: Acta Neuropathol Commun Date: 2019-09-05 Impact factor: 7.801
Authors: Lars B Hindenes; Asta K Håberg; Liv Hege Johnsen; Ellisiv B Mathiesen; David Robben; Torgil R Vangberg Journal: PLoS One Date: 2020-11-03 Impact factor: 3.240
Authors: Alexander I Zavriyev; Kutlu Kaya; Parisa Farzam; Parya Y Farzam; John Sunwoo; Arminder S Jassar; Thoralf M Sundt; Stefan A Carp; Maria Angela Franceschini; Jason Z Qu Journal: JTCVS Tech Date: 2021-01-29