Association Between The Posterior Part Of The Circle Of Willis And Vertebral Artery Hypoplasia

Abstract

BackgroundIt is not clear whether the configuration of the posterior part of the circle of Willis (CW) depends on the proximal part of the vertebrobasilar system. Our aim is to evaluate the posterior part of CW in association with different size of vertebral arteries (VA) in subjects free from stroke and TIA. Materials and methodsThe present study was based on a sample of 923 subjects free from stroke and TIA who were examined from 2013 through 2018. All the participants underwent MRA examination. The duplex ultrasonographic examination of the extracranial arteries (vertebral and carotid) was performed. VA was defined as hypoplastic (VAH) when VA diameter in the entire course was less than 2.5 mm. We classified the posterior communicating arteries (PCoA) as presence PCoA, absence/hypoplastic PCoA and fetal CW (FCW). The comparison of the posterior part of CW was made in subjects with normal VA and VAH of a different degree (communicating with basilar artery (VAH-BA) and not communicating with the basilar artery and terminating in PICA, neck or aplasia (VAH-PICA)). ResultsFCW was found in 15.9% of subjects, bilaterally - in 2.3 %. The coexisting VAH was more common in subjects with FCW rather than in those with adult CW (respectively, 28.6% and 13.4%, p<0.001). Aplasia of A1 of the anterior cerebral artery, i.e. blood flow redistribution in the anterior part of anterior circulation in the majority of cases (in 6 of 7 cases) was found ipsilaterally to FCW. FCW was recorded in 50% of the subjects with VA - PICA in comparison with 13.5% of those with normal VA and 22.8% with VAH - BA, p<0.005. On the contrary, absence/hypoplasia of both PCoA was mostly found in the group with normal VA in comparison with VAH-BA and VAH-PICA (accordingly, 50.7%, 38.6% and 12.5%, p<0.01). ConclusionIndividuals with VAH have a different pattern of the posterior part of CW in comparison with those with normal VA. With the increasing degree of VAH, the proportion of FCW increases, while the proportion of absence/hypoplastic of both PCoA decreases.