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Published online: 2023-10-06

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Hypoplastic arteries of the cerebral arterial ring in the blind spot of computed tomography angiography

Milena Trandafilović1, Miroslav Milić23, Aleksandra Antović23, Ivan Stojanović23, Voja Pavlović4, Stefan Todorović5, Gorazd Drevenšek6, Ljiljana Vasović7, Miljana Pavlović1, Martina Drevenšek89
Pubmed: 37822066

Abstract

Background: Some variations of the cerebral arterial circle (CAC) are associated with an increased risk for the development of various pathological conditions. This paper aimed to determine the prevalence of hypoplastic arteries of CAC and to emphasize the limited possibility of their visualization by computed tomography angiography (CTA).

Materials and methods: The research was performed on 400 adult cadavers by macro- and microdissection of the cerebral arteries. Each case was photographed and the diameter of the arteries was measured digitally, by analyzing photographs of the bases of the brain in the ImageJ program.

Results: The largest prevalence of artery diameter <1mm (<0.6mm) in CAC had the posterior communicating artery (PCoA). PCoA on the left side was hypoplastic in 44.9% (11.4%) of cases, while the same artery on the right side was hypoplastic in 44.3% (6.6%) of cases. The posterior cerebral artery was hypoplastic on the left side in 3% (0.6%) and on the right side in 4.2% (0.6%) of cases. The anterior cerebral artery had a hypoplastic caliber only on the right side in 2.4% (0.6%) of the cases, while the internal carotid arteries did not have a diameter <1mm in any case. The anterior communicating artery showed the greatest variability in morphology. Studies on CTA describe the occurrence of aplasia in a statistically significantly higher percentage, and the occurrence of hypoplastic arteries in a statistically significantly lower percentage compared to studies on cadavers.

Conclusions: Due to significant differences between cadaveric and radiological studies, it is necessary to analyze their results regarding arterial hypoplasia and aplasia separately. A diameter of less than 1 mm has been suggested as a criterion for arterial hypoplasia.

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References

  1. Al-Hussain SM, Shoter AM, Bataina ZM. Circle of Willis in adults. Saudi Med J. 2001; 22(10): 895–898.
  2. Ansari S, Dadmehr M, Eftekhar B, et al. A simple technique for morphological measurement of cerebral arterial circle variations using public domain software (Osiris). Anat Cell Biol. 2011; 44(4): 324–330.
  3. Battacharji SK, Hutchinson EC, McCall AJ. The Circle of Willis — the incidence of developmental abnormalities in normal and infarcted brains. Brain. 1967; 90(4): 747–758.
  4. Bor AS, Velthuis BK, Majoie CB, et al. Configuration of intracranial arteries and development of aneurysms: a follow-up study. Neurology. 2008; 70(9): 700–705.
  5. Burbank NS, Morris PP. Unique anomalous origin of the left anterior cerebral artery. AJNR Am J Neuroradiol. 2005; 26(10): 2533–2535.
  6. Chuang YM, Liu CY, Pan PJ, et al. Posterior communicating artery hypoplasia as a risk factor for acute ischemic stroke in the absence of carotid artery occlusion. J Clin Neurosci. 2008; 15(12): 1376–1381.
  7. Coulier B. Morphologic variants of the Cerebral Arterial Circle on computed tomographic angiography (CTA): a large retrospective study. Surg Radiol Anat. 2021; 43(3): 417–426.
  8. De Silva KR, Silva R, Amaratunga D, et al. Types of the cerebral arterial circle (circle of Willis) in a Sri Lankan population. BMC Neurol. 2011; 11: 5.
  9. Dimmick SJ, Faulder KC. Normal variants of the cerebral circulation at multidetector CT angiography. Radiographics. 2009; 29(4): 1027–1043.
  10. Eftekhar B, Dadmehr M, Ansari S, et al. Are the distributions of variations of circle of Willis different in different populations? — Results of an anatomical study and review of literature. BMC Neurol. 2006; 6: 22.
  11. Fujimoto K. 'Medial defects' in the prenatal human cerebral arteries: an electron microscopic study. Stroke. 1996; 27(4): 706–708.
  12. Goldman LW. Principles of CT: multislice CT. J Nucl Med Technol. 2008; 36(2): 57–68; quiz 75.
  13. Gunnal SA, Farooqui MS, Wabale RN. Anatomical variations of the circulus arteriosus in cadaveric human brains. Neurol Res Int. 2014; 2014: 687281.
  14. Hartkamp MJ, van Der Grond J, van Everdingen KJ, et al. Circle of Willis collateral flow investigated by magnetic resonance angiography. Stroke. 1999; 30(12): 2671–2678.
  15. Iwanaga J, Singh V, Takeda S, et al. Standardized statement for the ethical use of human cadaveric tissues in anatomy research papers: Recommendations from Anatomical Journal Editors-in-Chief. Clin Anat. 2022; 35(4): 526–528.
  16. Jiménez-Sosa M, Cantu-Gonzalez J, Morales-Avalos R, et al. Anatomical variants of anterior cerebral arterial circle: a study by multidetector computerized 3D tomographic angiography. Int J Morphol. 2017; 35(3): 1121–1128.
  17. Kamath S. Observations on the length and diameter of vessels forming the circle of Willis. J Anat. 1981; 133(Pt 3): 419–423.
  18. Kapoor K, Singh B, Dewan LI. Variations in the configuration of the circle of Willis. Anat Sci Int. 2008; 83(2): 96–106.
  19. Karatas A, Coban G, Cinar C, et al. Assessment of the Circle of Willis with cranial tomography angiography. Med Sci Monit. 2015; 21: 2647–2652.
  20. Klimek-Piotrowska W, Kopeć M, Kochana M, et al. Configurations of the circle of Willis: a computed tomography angiography based study on a Polish population. Folia Morphol. 2013; 72(4): 293–299.
  21. Kovač JD, Stanković A, Stanković D, et al. Intracranial arterial variations: a comprehensive evaluation using CT angiography. Med Sci Monit. 2014; 20: 420–427.
  22. Lazzaro MA, Ouyang B, Chen M. The role of circle of Willis anomalies in cerebral aneurysm rupture. J Neurointerv Surg. 2012; 4(1): 22–26.
  23. Machasio RM, Nyabanda R, Mutala TM. Proportion of variant anatomy of the circle of Willis and association with vascular anomalies on cerebral CT angiography. Radiol Res Pract. 2019; 2019: 6380801.
  24. Manninen H, Mäkinen K, Vanninen R, et al. How often does an incomplete circle of Willis predispose to cerebral ischemia during closure of carotid artery? Postmortem and clinical imaging studies. Acta Neurochir (Wien). 2009; 151(9): 1099–1105.
  25. Merkkola P, Tulla H, Ronkainen A, et al. Incomplete circle of Willis and right axillary artery perfusion. Ann Thorac Surg. 2006; 82(1): 74–79.
  26. Osborn AG. Diagnostic cerebral angiography. Lippincott Williams Wilkins, Philadelphia 1999.
  27. Papantchev V, Hristov S, Todorova D, et al. Some variations of the circle of Willis, important for cerebral protection in aortic surgery--a study in Eastern Europeans. Eur J Cardiothorac Surg. 2007; 31(6): 982–989.
  28. Papantchev V, Stoinova V, Aleksandrov A, et al. The role of Willis circle variations during unilateral selective cerebral perfusion: a study of 500 circles. Eur J Cardiothorac Surg. 2013; 44(4): 743–753.
  29. Pennekamp CWA, van Laar PJ, Hendrikse J, et al. Incompleteness of the circle of Willis is related to EEG-based shunting during carotid endarterectomy. Eur J Vasc Endovasc Surg. 2013; 46(6): 631–637.
  30. Perlmutter D, Rhoton AL, Perlmutter D, et al. Microsurgical anatomy of anterior cerebral anterior communicating recurrent artery complex. Surg Forum. 1976; 27(62): 464–465.
  31. Rinaldo L, McCutcheon BA, Murphy ME, et al. Relationship of A segment hypoplasia to anterior communicating artery aneurysm morphology and risk factors for aneurysm formation. J Neurosurg. 2017; 127(1): 89–95.
  32. Schomer DF, Marks MP, Steinberg GK, et al. The anatomy of the posterior communicating artery as a risk factor for ischemic cerebral infarction. N Engl J Med. 1994; 330(22): 1565–1570.
  33. Seeram E. Computed tomography: physical principles, patient care, clinical applications, and quality control. Elsevier Inc, Philadelphia 2022.
  34. Silver JM, Wilkins RH. Arterial embryology. In: persistent embryonic intracranial and extracranial vessels. In: Wilkins RH, Rengachary SS. ed. Neurosurgery Update II: Vascular, Spinal, Pediatric, and Functional Neurosurgery. McGraw-Hill, Health Professions Divisions, New York 1991: 50–51.
  35. Stock KW, Wetzel S, Kirsch E, et al. Anatomic evaluation of the circle of Willis: MR angiography versus intraarterial digital subtraction angiography. AJNR Am J Neuroradiol. 1996; 17(8): 1495–1499.
  36. van Raamt AF, Mali WP, van Laar PJ, et al. The fetal variant of the circle of Willis and its influence on the cerebral collateral circulation. Cerebrovasc Dis. 2006; 22(4): 217–224.
  37. Varga A, Di Leo G, Banga PV, et al. Multidetector CT angiography of the Circle of Willis: association of its variants with carotid artery disease and brain ischemia. Eur Radiol. 2019; 29(1): 46–56.
  38. Vasović LP, Jovanović ID, Ugrenović SZ, et al. Normal subtypes of the posterior part of the cerebral arterial circle in human fetuses. Surg Neurol. 2008; 70(3): 287–294.
  39. Vasović L, Trandafilović M, Jovanović I, et al. Morphology of the cerebral arterial circle in the prenatal and postnatal period of Serbian population. Childs Nerv Syst. 2013; 29(12): 2249–2261.
  40. Yasargil MG. Intracranial Arteries. In: Yasargil MG. ed. Operative Anatomy. Thieme, Sttutgart/New York 1984: 54–158.