An Experimental Study of the Effects Anatomical Variations Have on Collateral Flows Within the Circle of Willis

2011 ◽  
Author(s):  
Paul Fahy ◽  
Patrick Delassus ◽  
Padraig O’Flynn ◽  
Liam Morris
Keyword(s):  
Experimental Study ◽  
Blood Flow ◽  
Cerebral Arteries ◽  
Anatomical Variations ◽  
Flow Patterns ◽  
Circle Of Willis ◽  
Collateral Flow ◽  
Arterial Network ◽  
Flow Feature ◽  
The Brain

The circle of Willis (CoW) is a complex arterial network comprising of major cerebral arteries that converge to form a pentagonal arrangement as shown in Figure 1(A). This arterial network supplies oxygen-enriched blood to the brain. An incomplete CoW can exist in up to 50% of cases [1]. These missing vessels can be accommodated by the collateral flow feature within the CoW configuration. In certain circumstances, anatomical variations within the CoW can result in undesirable flow patterns [2–3]. It is unclear from the literature what effects these variations can have on blood flow collision paths within a complete CoW.

MODELING REDISTRIBUTION CEREBRAL CIRCULATION

2021 ◽  
Vol 1 (4) ◽  
pp. 13-18
Author(s):  
Vladislav Nikolaevich Nikitin ◽  
◽  
Ekaterina Valerevna Kozhemyakina ◽  
Keyword(s):  
Blood Flow ◽  
Internal Carotid ◽  
Cerebral Arteries ◽  
Circle Of Willis ◽  
Entire Body ◽  
Compensatory Mechanisms ◽  
Vertebral Arteries ◽  
The Central Nervous System ◽  
Flow Through ◽  
The Brain

The brain is one of the most important organs responsible for the health and functioning of the entire body. The blood supply to the brain is carried out through 2 internal carotid and 2 vertebral arteries in norm. The brain, like other body systems, has protective (compensatory) mechanisms aimed at maintaining the necessary blood flow, one of which is the circle of Willis. The article proposes a mechanism for how blood flow is redistributed through the arteries feeding the brain, which is based on the assumption that the central nervous system controls in such a way that it minimizes flows through the connective arteries of the circle of Willis, the flows along which are normal (with symmetry of the left and right sides) practically equal to zero. Сase of the structure of the circle of Willis is considered in norm. The indicated redistribution mechanism is still only the first step towards an attempt to predict cases of changes in blood flow through the cerebral arteries, especially in stroke. In further works, it is planned to consider the inverse problem, i.e. determine the flows through the internal carotid and vertebral arteries, provided that the flows through the cerebral arteries extending from the circle of Willis have normal flow values.

Real-time detection of vascular occlusion and reperfusion of the brain during surgery by using infrared imaging

2002 ◽  
Vol 96 (5) ◽  
pp. 918-923 ◽  
Author(s):  
Joseph C. Watson ◽  
Alexander M. Gorbach ◽  
Ryszard M. Pluta ◽  
Ramin Rak ◽  
John D. Heiss ◽  
...  
Keyword(s):  
Blood Flow ◽  
High Resolution ◽  
Real Time ◽  
Infrared Imaging ◽  
Cerebral Arteries ◽  
Infrared Camera ◽  
Collateral Flow ◽  
Content Type ◽  
The Brain ◽  
Fine Print

Object. Application of sensitive infrared imaging is ideally suited to observe blood vessels and blood flow in exposed organs, including the brain. Temporary vascular occlusion is an important part of neurosurgery, but the capacity to monitor the effects of these occlusions in real time is limited. In surgical procedures that require vascular manipulation, such as those involving aneurysms, arteriovenous malformations (AVMs), or tumors, the ability to visualize blood flow in vessels and their distribution beds would be beneficial. The authors recount their experience in the use of a sensitive (0.02°C), high-resolution (up to 50 µm/pixel) infrared camera with a rapid shutter speed (up to 2 msec/frame) for localizing cortical function intraoperatively. They observed high-resolution images of cerebral arteries and veins. The authors hypothesized that infrared imaging of cerebral arteries, performed using a sensitive, high-resolution camera during surgery, would permit changes in arterial flow to be be seen immediately, thus providing real-time assessment of brain perfusion in the involved vascular territory. Methods. Cynomolgus monkeys underwent extensive craniectomies, exposing the frontal, parietal, and temporal lobes. Temporary occlusions of the internal carotid artery and middle cerebral artery branches (30 events) were performed serially and were visualized with the aid of an infrared camera. Arteries and veins of the monkey brain were clearly visualized due to cooling of the exposed brain, which contrasted with blood within the vessels that remained at core temperature. Blood flow changes in vessels were seen immediately (< 1 second) in real time during occlusion and reopening of the vessels, regardless of the duration of the occlusion. Areas of decreased cortical blood flow rapidly cooled (−0.3 to 1.3°C) and reheated in response to reperfusion. Rewarming occurred faster in arteries than in the cortex (for a 20-minute occlusion, the change in temperature per second was 2 × 10−2°C in the artery and 7 × 10−3°C in the brain). Collateral flow could be evaluated by intraoperative observations and data processing. Conclusions. Use of high-resolution, digital infrared imaging permits real-time visualization of arterial flow. It has the potential to provide the surgeon with a means to assess collateral flow during temporary vessel occlusion and to visualize directly the flow in parent arteries or persistent filling of an aneurysm after clipping. During surgery for AVMs, the technique may provide a new way to assess arterial inflow, venous outflow, results of embolization, collateral flow, steal, and normal perfusion pressure breakthrough.

scholarly journals Analyzing Circle of Willis blood flow in ischemic stroke patients through 3D Stroke Arterial Flow Estimation

2017 ◽  
Vol 23 (4) ◽  
pp. 427-432 ◽  
Author(s):  
Aichi Chien ◽  
Fernando Viñuela
Keyword(s):  
Blood Flow ◽  
Ischemic Stroke ◽  
Flow Patterns ◽  
Circle Of Willis ◽  
Arterial Flow ◽  
Patient Specific ◽  
Collateral Flow ◽  
Flow Data ◽  
Time Resolved ◽  
Flow Estimation

Background The objective of ischemic stroke (IS) treatment is to achieve revascularization in cerebral arteries to restore blood flow. However, there is no available method to extract arterial flow data from clinical CTA images. We developed 3D Stroke Arterial Flow Estimation (SAFE), which provides blood flow data throughout the Circle of Willis based on 3D CTA and allows comparison of arterial flow distribution in the brain. Methods We implemented a newly developed 3D vascular reconstruction algorithm for clinical stroke CTA images. Based on the patient-specific vascular structure, SAFE calculates time-resolved blood flow information for the entire Circle of Willis and allows quantitative flow study of IS cases. Clinical IS cases are presented to demonstrate the feasibility. Four patients with CTA images and CT perfusion data were studied. To validate the SAFE analysis, correlation analysis comparing blood flow at the MCA, ICA, and BA was performed. Results Different blood flow patterns were found in individual IS patients. Altered flow patterns and high collateral flow rates were found near occlusions in all cases. Quantitative comparison of blood flow data showed that SAFE obtained flow data and CTP were significantly correlated and provide complementary information about cerebral blood flow for individual patients. Conclusions We present SAFE analysis for collecting detailed time-resolved cerebral arterial flow data in the entire Circle of Willis for IS. Further study with more cases may be important to test the clinical utilization of SAFE and helpful to the study of the underlying hemodynamics of stroke.

scholarly journals The Role Of Circle Of Willis Anatomy Variations In Cardio-embolic Stroke - A Patient-specific Simulation Based Study

2017 ◽  
Author(s):  
Debanjan Mukherjee ◽  
Neel D. Jani ◽  
Jared Narvid ◽  
Shawn C. Shadden
Keyword(s):  
Cerebral Arteries ◽  
Density Ratio ◽  
Flow Simulation ◽  
Anatomical Variations ◽  
Circle Of Willis ◽  
Patient Specific ◽  
Simulation Based ◽  
Flow Through ◽  
The Brain

AbstractWe describe a patient-specific simulation based investigation on the role of Circle of Willis anatomy in cardioembolic stroke. Our simulation framework consists of medical image-driven modeling of patient anatomy including the Circle, 3D blood flow simulation through patient vasculature, embolus transport modeling using a discrete particle dynamics technique, and a sampling based approach to incorporate parametric variations. A total of 24 (four patients and six Circle anatomies including the complete Circle) models were considered, with cardiogenic emboli of varying sizes and compositions released virtually and tracked to compute distribution to the brain. The results establish that Circle anatomical variations significantly influence embolus distribution to the six major cerebral arteries. Embolus distribution to MCA territory is found to be least sensitive to the influence of anatomical variations. For varying Circle topologies, differences in flow through cervical vasculature are observed. This incoming flow is recruited differently across the communicating arteries of the Circle for varying anastomoses. Emboli interact with the routed flow, and can undergo significant traversal across the Circle arterial segments, depending upon their inertia and density ratio with respect to blood. This interaction drives the underlying biomechanics of embolus transport across the Circle, explaining how Circle anatomy influences embolism risk.

scholarly journals Echo-Enhanced Transcranial Color Coded Duplexsonography versus Digital Subtraction Angiography for Diagnosis of Intracranial Vascular Diseases

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 340-340
Author(s):  
Alexander Kunz
Keyword(s):  
Digital Subtraction Angiography ◽  
Cerebral Arteries ◽  
Vascular Diseases ◽  
Flow Patterns ◽  
Circle Of Willis ◽  
Collateral Flow ◽  
Digital Subtraction ◽  
Diagnostic Efficacy ◽  
Basilar Artery Thrombosis ◽  
Cerebrovascular Symptoms

P7 Objective: To assess the diagnostic efficacy of echo-enhanced transcranial color coded duplexsonography (eTCCD) for noninvasive evaluation of the intracranial vasculature in patients with cerebrovascular symptoms. MATERIAL AND METHODS: We prospectively evaluated 35 consecutive patients (10 women, 25 men, mean age 58,8 ± 9,7) with eTCCD (galactose palmitic acid based echo-enhancing agent) and digital subtraction angiography (DSA). All patients were admitted to our neurology department for acute onset of cerebrovascular symptoms. RESULTS: In 34/35 patients eTCCD visualized the circle of Willis. In 15/17 patients with critical symptomatic internal carotid artery obstruction (lumen diameter reduction of >85% or occlusion) eTCCD correctly identified collateral flow patterns through the circle of Willis. DSA and eTCCD showed MCA-occlusion in 4 patients. In one of these patients eTCCD correctly identified a contralateral severe MCA-stenosis, which was first missed by DSA but confirmed by angiographic reevaluation. In 1 patient eTCCD missed occlusion of a M3-segment. In 2/3 patients eTCCD showed intracranial ICA-stenosis. In 3 patients with symptoms suggestive for basilar artery thrombosis DSA and eTCCD showed severe basilar stenosis in 1 patient and intracranial vertebral artery occlusion in 2 patients. DSA and eTCCD were normal in 3 patients with atypical intracranial hemorrhages and in 1 patient with subarachnoid hemorrhage. In another patient eTCCD correctly suggested a left parietooccipital AVM. DSA and eTCCD were normal in 4 other patients. CONCLUSION: eTCCD reliably detects occlusion, stenosis and collateral flow patterns of the basal cerebral arteries in patients with cerebral ischemia. For patients with cerebral hemorrhage our data are limited.

An In Vitro Assessment of the Cerebral Hemodynamics Through Three Patient Specific Circle of Willis Geometries

2013 ◽  
Vol 136 (1) ◽  
Author(s):  
Paul Fahy ◽  
Patrick Delassus ◽  
Peter McCarthy ◽  
Sheriff Sultan ◽  
Niamh Hynes ◽  
...  
Keyword(s):  
Spin Coating ◽  
Internal Carotid ◽  
Circle Of Willis ◽  
Patient Specific ◽  
Collateral Flow ◽  
Flow Paths ◽  
Flow Rates ◽  
Vertebral Arteries ◽  
Flow Feature ◽  
The Brain

The Circle of Willis (CoW) is a complex pentagonal network comprised of fourteen cerebral vessels located at the base of the brain. The collateral flow feature within the circle of Willis allows the ability to maintain cerebral perfusion of the brain. Unfortunately, this collateral flow feature can create undesirable flow impact locations due to anatomical variations within the CoW. The interaction between hemodynamic forces and the arterial wall are believed to be involved in the formation of cerebral aneurysms, especially at irregular geometries such as tortuous segments, bends, and bifurcations. The highest propensity of aneurysm formation is known to form at the anterior communicating artery (AcoA) and at the junctions of the internal carotid and posterior communicating arteries (PcoAs). Controversy still remains as to the existence of blood flow paths through the communicating arteries for a normal CoW. This paper experimentally describes the hemodynamic conditions through three thin walled patient specific models of a complete CoW based on medical images. These models were manufactured by a horizontal dip spin coating method and positioned within a custom made cerebral testing system that simulated symmetrical physiological afferent flow conditions through the internal carotid and vertebral arteries. The dip spin coating procedure produced excellent dimensional accuracy. There was an average of less than 4% variation in diameters and wall thicknesses throughout all manufactured CoW models. Our cerebral test facility demonstrated excellent cycle to cycle repeatability, with variations of less than 2% and 1% for the time and cycle averaged flow rates, respectively. The peak systolic flow rates had less than a 4% variation. Our flow visualizations showed four independent flow sources originating from all four inlet arteries impacting at and crossing the AcoA with bidirectional cross flows. The flow paths entering the left and right vertebral arteries dissipated throughout the CoW vasculature from the posterior to anterior sides, exiting through all efferent vessels. Two of the models had five flow impact locations, while the third model had an additional two impact locations within the posterior circulation caused by an additional bidirectional cross flows along the PcoAs during the accelerating and part of the decelerating phases. For a complete CoW, bidirectional cross flows exist within the AcoA and geometrical variations within the CoW geometry can either promote uni- or bidirectional cross flows along the PcoAs.

scholarly journals Function of Circle of Willis

2014 ◽  
Vol 34 (4) ◽  
pp. 578-584 ◽  
Author(s):  
Zvonimir Vrselja ◽  
Hrvoje Brkic ◽  
Stefan Mrdenovic ◽  
Radivoje Radic ◽  
Goran Curic
Keyword(s):  
Blood Flow ◽  
Pulse Wave ◽  
Cerebral Arteries ◽  
Arterial Occlusion ◽  
Current Theory ◽  
Circle Of Willis ◽  
Arterial Tree ◽  
Passive Pressure ◽  
Flow Pressure ◽  
The Brain

Nearly 400 years ago, Thomas Willis described the arterial ring at the base of the brain (the circle of Willis, CW) and recognized it as a compensatory system in the case of arterial occlusion. This theory is still accepted. We present several arguments that via negativa should discard the compensatory theory. (1) Current theory is anthropocentric; it ignores other species and their analog structures. (2) Arterial pathologies are diseases of old age, appearing after gene propagation. (3) According to the current theory, evolution has foresight. (4) Its commonness among animals indicates that it is probably a convergent evolutionary structure. (5) It was observed that communicating arteries are too small for effective blood flow, and (6) missing or hypoplastic in the majority of the population. We infer that CW, under physiologic conditions, serves as a passive pressure dissipating system; without considerable blood flow, pressure is transferred from the high to low pressure end, the latter being another arterial component of CW. Pressure gradient exists because pulse wave and blood flow arrive into the skull through different cerebral arteries asynchronously, due to arterial tree asymmetry. Therefore, CW and its communicating arteries protect cerebral artery and blood–brain barrier from hemodynamic stress.

Abstract 1122‐000181: Collateral Circulation in Ischemic Stroke is Not Determined by Anatomical Variants of the Cerebral Arteries

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Karolina Brzegowy ◽  
Bernard Solewski ◽  
Paweł Brzegowy ◽  
Agata Musiał ◽  
Tadeusz Popiela ◽  
...  
Keyword(s):  
Blood Flow ◽  
Ischemic Stroke ◽  
Collateral Circulation ◽  
Cerebral Arteries ◽  
Anatomical Variations ◽  
Detailed Knowledge ◽  
Collateral Blood Flow ◽  
Posterior Portion ◽  
Cortical Vein ◽  
Anatomical Variants

Introduction : In acute ischemic stroke, collateral circulation determines tissue fate and treatment results. The aim of this study was to evaluate the role of anatomical variations of the Circle of Willis (CoW) in formation of cerebral collateral blood flow in patients with acute M1 occlusion. Methods : This study was a retrospective assessment of radiological examinations of patients with stroke due to middle cerebral artery M1 segment occlusion. All patients underwent mechanical thrombectomy from January 2015 until March 2021. The anatomy of the CoW was assessed on initial CT‐angiography and DSA. CTA was utilized to grade cranial collateral vasculature status and cortical vein opacification score (COVES). Non‐contrast CT scans and ASPECTS scores (using RAPID software) were used to determine the ischemic area. Results : A total of 100 patients were included in the analysis (58 females and 42 males, mean age: 71.6 +/‐ 13.9). We classified the anatomy of the CoW according to its continuity as a full circle. Patients with fully continuous CoW (n = 19) had worse COVES scores than those with CoW incomplete at both anterior and posterior portion (n = 9) (89% vs 68% with COVES 0–2, p = 0.179). No statistically significant results were found when comparing the enhancement of collaterals between these two groups (p = 0.390). The COVES scores were similar for patients with complete and incomplete anterior portions of CoW (77% vs 80% with COVES 0–2, p = 0.812). Patients with incomplete posterior portions of CoW had lower COVES scores than those with complete (80% vs 67% with COVES 0–2, p = 0.206). No statistically significant differences were discovered when comparing different types of the posterior communicating artery (adult, transitional and fetal). Analysis of ischemic areas determined as ASPECTS scores pre‐ and post‐thrombectomy yielded no significant differences between any of the groups. Conclusions : Although certain variants of the CoW have been reported to increase the risk of ischemic stroke, our results show that the anatomy of CoW has no large effect on collateral blood flow during acute M1 occlusion. We presume that the greater role is played by pial arterioles than anatomical variants of major cerebral arteries in cerebral collateral circulation formation. Detailed knowledge about the factors that influence collateral blood flow is crucial as it may aid in identification of patients prone to worse outcomes of ischemic stroke. Anatomical variants of CoW do not play a major role in formation of cerebral collaterals.

scholarly journals Average dimensions of the vessels at the base of the brain and the embryological basis of its variations

2013 ◽  
Vol 02 (04) ◽  
pp. 180-189
Author(s):  
Iqbal S.
Keyword(s):  
Anterior Part ◽  
Cerebral Arteries ◽  
Cerebral Dominance ◽  
Circle Of Willis ◽  
Detailed Knowledge ◽  
Differential Growth ◽  
Ischemic Attack ◽  
The Individual ◽  
The Right ◽  
The Brain

Abstract Background and aims: The cerebral circulation is constantly maintained by the anastomotic circle of Willis which is often anomalous in more than 50% of the normal adult brains. These anomalies increase the risk of the stroke and transient ischemic attack in older patients. Adequate blood flow through the circle of Willis is often necessary to prevent these ischemic infarctions. The anomalies of cerebral vessels are directly related to the differential growth of various parts of the brain. A detailed knowledge of the individual measurements of the cerebral arteries is useful to neurosurgeon in planning the shunt operations and in the choice of their patients. The present study is aimed to analyze the average dimensions of the vessels at the base of brain and an attempt to explain the common form of variations in terms of embryological development. Materials and methods: Fifty adult cadaveric brains were obtained from routine cadaveric dissections. The base of the brain with the circle of Willis was fixed in 10% formalin and preserved. The circle was analyzed for variations in the size, length and number of the component vessels and any asymmetry in the configuration. The dimensions of the vessels forming the circle were measured using graduated calipers. The observations were recorded and tabulated. Results: Asymmetry was observed in 10% to 36% of the circles in this study. Anomalies were more common in the posterior than in the anterior part of the circle. The posterior anomalies included hypoplastic vessels, absent vessels and embryonic derivation while anterior anomalies were predominantly of accessory vessels. Middle cerebral artery exhibited the least variations. In majority of the circles, left sided vessels were larger in diameter than the right. Conclusions: Variations are more common in the posterior than in the anterior part of the circle and on the right than on the left side of the brain. There was no correlation between the variations of circle of Willis of the right side and the left cerebral dominance. There seems to be no difference between races, concerning the anatomic variations of the brain circulation.

Computational Fluid Dynamics Simulation of the Blood Flow in the Circle of Willis

2002 ◽  
Author(s):  
M. Harazawa ◽  
T. Yamaguchi
Keyword(s):  
Blood Flow ◽  
Blood Supply ◽  
Internal Carotid ◽  
Complex Geometry ◽  
Cerebral Aneurysms ◽  
Cerebrovascular Diseases ◽  
Circle Of Willis ◽  
Dynamics Simulation ◽  
The Brain ◽  
Internal Carotid Arteries

The blood supply for the brain is born by four arteries, that is, two internal carotid arteries and two vertebral arteries. They are mutually connected at the cerebral base, and form a closed arterial circle, called the circle of Willis, so that the safety of the brain blood supply is increased. However their anastomoses show a very wide variety of atypism. If some of anastomses are very thin, or even do not exist, the safety of the blood supply is not secured. This is particularly important when some diseases such as cerebral thrombosis occurs and the blood flow supply stops unilaterally. Redistribution of the blood supply in such cases is thought to be strongly affected by geometrical configuration of the anastomoses. It is also known that cerebral aneurysms, which may induce serious cerebrovascular diseases, preferentially occur at the circle of Willis. Complex blood flow pattern has been suspected of having an influence on this preference. This is again dependent on complex geometry of the circle.

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