• Midas Meijs, Frank-Erik de Leeuw, Hieronymus D Boogaarts, Rashindra Manniesing, and Frederick Jan Anton Meijer.
• Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
• World Neurosurg. 2018 Jun 1; 114: 421-426.e1.

BackgroundIn case of carotid artery occlusion, the risk and extent of ischemic cerebral damage are highly dependent on the pathways of collateral flow including the anatomy of the circle of Willis. In this report, cases are presented to illustrate that 4-dimensional computed tomography angiography (4D-CTA) can be considered as a noninvasive alternative to digital subtraction angiography for the evaluation of circle of Willis collateral flow.Case DescriptionFive patients with unilateral internal carotid artery (ICA) occlusion underwent 4D-CTA for the evaluation of intracranial hemodynamics. Next to a visual evaluation of 4D-CTA, temporal information was visualized using a normalized color scale on the cerebral vasculature, which enabled quantification of the contrast bolus arrival time. In these patients, 4D-CTA demonstrated dominant middle cerebral artery blood supply on the side of ICA occlusion originating from either the contralateral ICA or posterior circulation via the communicating arteries.ConclusionsTemporal dynamics of collateral flow in the circle of Willis can be depicted with 4D-CTA in patients with a unilateral carotid artery occlusion.Copyright © 2018 Elsevier Inc. All rights reserved.

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