Medical College of Wisconsin
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The role of circle of Willis anomalies in cerebral aneurysm rupture. J Neurointerv Surg 2012 Jan 01;4(1):22-6

Date

10/13/2011

Pubmed ID

21990452

DOI

10.1136/jnis.2010.004358

Scopus ID

2-s2.0-84455173315 (requires institutional sign-in at Scopus site)   55 Citations

Abstract

BACKGROUND AND PURPOSE: Limited data exist to guide patient selection for preventive treatment of unruptured cerebral aneurysms. Cerebral aneurysms have been associated with circle of Willis anomalies but whether this association is also related to aneurysm rupture is not known. The occurrence of cerebral aneurysm rupture when a circle of Willis anomaly was present or absent was compared.

METHODS: Patients admitted over a 2 year period with a diagnosis of a cerebral aneurysm and an anterior communicating artery (ACoA) or posterior communicating artery (PCoA) aneurysm were included in the analysis. Brain vascular imaging was reviewed for aneurysm size, morphology and presence of circle of Willis anomaly. Relevant medical history and demographics were obtained from the medical records.

RESULTS: Of the 113 patients with ACoA or PCoA aneurysms, 85 (75.2%) cases were ruptured. There were 49 (43.4%) PCoA aneurysms and 64 (56.6%) ACoA aneurysms. Mean aneurysm size was 5.65 mm (SD 3.31). A circle of Willis anomaly was identified in 46 (40.7%) of all patients. Circle of Willis anomalies were present in 38 (46.9%) ruptured aneurysm cases and eight (29.6%) unruptured aneurysm cases. Multivariate analysis revealed a higher risk of aneurysm rupture when a circle of Willis anomaly was present (p=0.0245, OR 3.72 (CI 1.18 to 11.66)).

CONCLUSIONS: This series shows that circle of Willis anomalies are more commonly found in ruptured as opposed to unruptured cerebral aneurysms of the anterior and posterior communicating arteries. The presence of a circle of Willis anomaly may be an important characteristic for selecting patients for preventive aneurysm treatment.

Author List

Lazzaro MA, Ouyang B, Chen M

Author

Marc A. Lazzaro MD Associate Professor in the Neurology department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Aneurysm, Ruptured
Circle of Willis
Female
Follow-Up Studies
Humans
Intracranial Aneurysm
Male
Middle Aged
Prospective Studies
Radiography