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. 2023;52(4):480-486.
doi: 10.1159/000527432. Epub 2022 Nov 29.

Association between Anatomical Variations of the Circle of Willis and Covert Vascular Brain Injury in the General Population

Lu Feng  1 , Fei-Fei Zhai  2 , Ming-Li Li  3 , Li-Xin Zhou  2 , Jun Ni  2 , Ming Yao  2 , Zheng-Yu Jin  3 , Li-Ying Cui  2 , Shu-Yang Zhang  4 , Fei Han  2 , Yi-Cheng Zhu  2
Affiliations

Association between Anatomical Variations of the Circle of Willis and Covert Vascular Brain Injury in the General Population

Lu Feng et al. Cerebrovasc Dis. 2023.

Abstract

Background and purpose: The circle of Willis (COW) is a circulatory anastomosis located at the base of the brain. Little is known about the association between covert vascular brain injury and COW configurations in the general population. We explored this relationship in a community-based Chinese sample.

Methods: A total of 1,055 patients (mean age, 54.8 ± 8.9 years; 36.0% men) without intracranial arterial stenosis were included in the analysis. Magnetic resonance imaging was performed to evaluate the presence of imaging markers of covert vascular brain injury, including white matter hyperintensities (WMHs), lacunes, cerebral microbleeds (CMBs), enlarged perivascular spaces, and brain atrophy. Magnetic resonance angiography was used to classify the COW configurations according to the completeness, symmetry, and presence of the fetal posterior cerebral artery (FTP). The association between vascular lesions and variations in COW was analyzed.

Results: Among the 1,055 patients, 104 (9.9%) had a complete COW. Completeness correlated with age (p = 0.001). Incomplete COW was positively associated with WMH severity (OR = 2.071; 95% CI, 1.004-4.270) and CMB presence (OR = 1.542; 95% CI, 1.012-2.348), independent of age and sex. The presence of FTP was associated with lacunes (OR = 1.878; 95% CI, 1.069-3.298), more severe WMHs (OR = 1.739; 95% CI, 1.064-2.842), and less severe enlarged perivascular spaces (OR = 0.562; 95% CI, 0.346-0.915).

Conclusions: COW configuration was significantly related to various covert vascular brain injuries.

Keywords: Cerebral microbleed; Circle of Willis; Lacunes; Perivascular space; White matter hyperintensity.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1.
Fig. 1.
Participant selection flowchart.
Fig. 2.
Fig. 2.
Variants of the COW in anterior and posterior circulation. a Variants in anterior circulation. Type I, two normal A1 + AcomA; type II, normal A1 + hypoplastic A1 + AcomA; type III, normal A1 + missing A1 + AcomA; type IV, two normal A1; type V, normal A1 + hypoplastic A1. b Variants in posterior circulation. Type A, two normal P1 + two PcomA; type B, two hypoplastic P1 + two PcomA; type C, normal P1 + hypoplastic P1 + two PcomA; type D, two normal P1; type E, two normal P1 + one PcomA; type F, normal P1 + hypoplastic P1 + one PcomA; type G, normal P1 + missing P1 + one PcomA; type H, normal P1 + missing P1 + two PcomA; type I, hypoplastic P1 + missing P1 + two PcomA; type J, two missing P1 + two PcomA; type K, two homolateral PCA extended from the internal carotid and basilar arteries.
See this image and copyright information in PMC

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