• World Neurosurg · Oct 2024

    Patterns of Dynamic Adaptability of the Circle of Willis in Response to Major Branch Artery Coverage with a Flow Diverter.

    • Felipe Ramirez-Velandia, Emmanuel Mensah, Mira Salih, Philipp Taussky, Justin H Granstein, and Christopher S Ogilvy.
    • Neurosurgical Service, Beth Israel Deaconess Medical Center. Boston, MA, United States.
    • World Neurosurg. 2024 Oct 19.

    BackgroundThe plasticity of the Circle of Willis represents an underexplored yet intriguing dimension of vascular anatomy in cerebrovascular disorders. We outline distinct patterns of change in response to aneurysm treatment using flow diversion (FD) after covering major branches.MethodsRetrospective analysis of digital subtraction angiographies (DSA) from intracranial aneurysms treated with FD from 2013 to 2023. Vessel diameters, including those covered by the stent and adjacent arteries, were measured. Angiographic changes were evaluated at last imaging follow-up.ResultsOf the 622 patients, 49 had angiographic follow-up for pattern assessment. The median age was 62 years; females represented 71.4%. The median size of the treated aneurysms was 4.7mm. Four patterns of angiographic change were identified: (1)Patients with supraclinoid aneurysms, A1-ACA caliber increased (hypoplastic: 1.05 to 2.00 mm; non-hypoplastic: 2.45 to 2.75 mm) after FD coverage of the contralateral ACA. (2)Patients with paraclinoid aneurysms and hypoplastic-fetal P1-PCA, the diameter increased from 0.80 to 1.7 mm (p<0.01) after covering the ipsilateral PComA origin. (3)Patients with basilar-tip and proximal PCA aneurysms showed increased ipsilateral PComA size from 1.2 to 2 mm (p<0.01) after PCA origin coverage. (4)Patients with anterior communicating aneurysms, the diameter of the contralateral hypoplastic A1 segment increased from 1.0 to 1.35 mm (p=0.39) or non-hypoplastic A1-ACA from 2.75 to 3.05 mm (p=0.10) after FD coverage.ConclusionThe circle of Willis displays both hemodynamic and anatomic plasticity after major branch coverage with a flow diverter. This phenomenon is aimed at preserving blood flow in the distal territory of the covered vessel.Copyright © 2024. Published by Elsevier Inc.

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