Extraluminal Protruding Plaques in Intracranial Arteries. An Angiographic and Pathological Analysis of Circle of Willis Specimens from the Nun Study (PD2.007)

BACKGROUND There is little data about extraluminal protruding plaques in intracranial arteries. Such plaques may not cause luminal stenosis and may be undetectable by standard angiographic modalities. It is important to identify the prevalence of such plaques because these plaques may be a cause of thrombosis and ischemic events in patients with cryptogenic strokes. OBJECTIVE To identify the prevalence of extraluminal protruding plaques in intracranial arteries from autopsy specimens of Nun Study. METHODS A random sample of 54 specimens was selected from Nun Study repository of post-mortem intracranial arteries (Circle of Willis). The Nun Study is a longitudinal study of aging and Alzheimer's disease funded by the National Institute on Aging including 678 participants who are 75 to 106 years of age. Basilar artery and proximal middle cerebral arteries were inspected and arteries with plaques were identified. The specimens were placed in a liquid container and an angiographic catheter was placed in vessel of interest. Using iodinated contrast media and Ziehm Vista C-arm, angiography was obtained in multiple planes. Percentage luminal stenosis was measured using normal proximal or distal segment of the vessel as reference. Using microscopic images, extraluminal protruding plaques was then sequentially measured. Percentage increase in extraluminal wall diameter was calculated as (extraluminal diameter at plaque site - normal diameter)/normal diameter x100. RESULTS Out of 162 samples, plaques were identified in 126 samples. The characteristics of the plaques are tabulated. The percentage increase in extraluminal wall diameter was 10.33 ± 8.13. For vessel with angiographically occult plaques, the percentage increase in extraluminal wall diameter was 9.2±3.2. In extraluminal protruding plaques, the median protrusion was 0.3 mm and maximum protrusion was 0.9 mm. There was no difference between the percentage extraluminal protrusion between the middle cerebral (0.3±0.1) and basilar artery plaques (0.36±0.2), p=0.8. The frequency of extraluminal plaques without angiographic stenosis of any severity was higher than extraluminal plaques with angiographic stenosis (52% and 56% for middle cerebral artery and basilar artery, respectively). CONCLUSIONS There appears to be a high prevalence of extraluminal protruding plaques among elderly persons and most of these plaques are not detected by angiography. Newer, imaging modalities like vessel wall high resolution visusalization by magnetic resonance imaging may help identify the prevalencc and ischemic event risk associated with such plaques.

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Hemodynamic Solution Computation and Pathological Analysis in the Circle of Willis

Journal of Medical Systems ◽

10.1007/s10916-018-1032-4 ◽

2018 ◽

Vol 42 (10) ◽

Author(s):

Jinxue Sui ◽

Li Yang ◽

Xinguang Zhang ◽

Hongzhi Shi ◽

Ya Hu

Keyword(s):

Circle Of Willis ◽

Pathological Analysis

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Impact of gender and age on inner diameter of arteries forming circle of Willis assessed by multidetector CT

Journal of Brain and Spine Foundation Nepal ◽

10.3126/jbsfn.v2i1.39016 ◽

2021 ◽

Vol 2 (1) ◽

pp. 37-41

Author(s):

Prakash Sharma ◽

Subita Lalchan ◽

Subhash KC ◽

Merina Gyawali ◽

Niraj Kushwaha

Keyword(s):

Cerebral Artery ◽

Basilar Artery ◽

Multidetector Ct ◽

Circle Of Willis ◽

Anterior Communicating Artery ◽

Internal Diameter ◽

Age Group ◽

Technical Standards ◽

Intracranial Arteries ◽

The Brain

Introduction: The circle of Willis (CoW), which is located at the base of the brain is the most important anastomosis between the internal carotid and vertebral system. It is the main distributor of blood to the brain. Methods: CT head and CT angiography were performed using standard scan parameters. Only the tests with normal radiological reports and appropriate technical standards were included in the study. Component of circle of Willis: Anterior cerebral artery (ACA), Middle cerebral artery (MCA), Anterior communicating artery (Acom), Posterior Communicating artery (PCom), Basilar artery (BA) and Posterior cerebral artery (PCA) were identified and their internal diameter were measured. Results: Basilar artery was the artery with largest internal diameter with mean diameter of 2.5 ±0.52 mm. Men had significantly larger arterial sizes than women in all of the intracranial arteries examined except right PCom, Left PCom and right MCA. Right ACA had significantly larger internal diameter in <40 years’ age group. BA, left PCA, Bilateral PCom and MCA showed larger diameter in age group ≥40 years. Conclusion: Men had significantly larger arterial sizes than women in all of the intracranial arteries examined except right PCom, Left PCom and right MCA.

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Dr. Thomas Willis and his ‘Circle’ in the Brain

Nepal Journal of Neuroscience ◽

10.3126/njn.v2i1.19999 ◽

2005 ◽

Vol 2 (1) ◽

pp. 77-79 ◽

Cited By ~ 4

Author(s):

PVS Rana

Keyword(s):

Medical Science ◽

Vascular Anatomy ◽

Circle Of Willis ◽

Short Description ◽

Accurate Description ◽

Accurate Knowledge ◽

Arterial Anastomosis ◽

Intracranial Arteries ◽

The Brain

With the advances in microneurosurgery and the ability to tackle diseases of the intracranial arteries at the base of the brain (often referred to as the Circle of Willis) surgically more effectively, accurate knowledge of the intracranial vascular anatomy is increasingly important. Although Dr. Thomas Willis is best remembered for the accurate description of arterial anastomosis at the baseof the brain, his contribution to neuroanatomy, physiology and medical science in general is vast, and several diseases bear his name. In this article an attempt has been made to review the life of Dr. Willis followed by a short description of the “Circle of Willis.” Nepal Journal of Neuroscience, Volume 2, Number 1, 2005, Page: 77-79

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Data on vessel wall thickness measurements of intracranial arteries derived from human circle of Willis specimens

Data in Brief ◽

10.1016/j.dib.2018.04.116 ◽

2018 ◽

Vol 19 ◽

pp. 6-12 ◽

Cited By ~ 5

Author(s):

Anita A. Harteveld ◽

Nerissa P. Denswil ◽

Wim Van Hecke ◽

Hugo J. Kuijf ◽

Aryan Vink ◽

...

Keyword(s):

Wall Thickness ◽

Vessel Wall ◽

Circle Of Willis ◽

Vessel Wall Thickness ◽

Intracranial Arteries ◽

Thickness Measurements

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Comparative in vivo and pathological analysis of the blood-brain barrier in mouse telencephalic transplants

Neuropathology and Applied Neurobiology ◽

10.1046/j.1365-2990.1996.3198031.x ◽

1996 ◽

Vol 22 (2) ◽

pp. 118-128 ◽

Cited By ~ 1

Author(s):

S. Isenmann ◽

S. Brandner ◽

G. Kuhne ◽

J. Boner ◽

A. Aguzzi

Keyword(s):

Blood Brain Barrier ◽

Brain Barrier ◽

Pathological Analysis ◽

Blood Brain

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Treatment of an asymptomatic penetrating aortic ulcer in a young patient

VASA ◽

10.1024/0301-1526/a000024 ◽

2010 ◽

Vol 39 (2) ◽

pp. 175-179

Author(s):

Hakimi ◽

Geisbüsch ◽

Gross ◽

Hyhlik-Dürr ◽

Hausser ◽

...

Keyword(s):

Electron Microscopy ◽

Connective Tissue ◽

Aortic Arch ◽

Open Surgery ◽

Open Repair ◽

Thoracic Endovascular Aortic Repair ◽

Concomitant Disease ◽

Connective Tissue Disorders ◽

Penetrating Aortic Ulcer ◽

Pathological Analysis

We want to report and discuss the indication for open surgery for an asymptomatic penetrating aortic ulcer (PAU) in the era of thoracic endovascular aortic repair (TEVAR). A 31-year-old female presented with the diagnosis of an aneurysm in the distal aortic arch. With respect to the patients young age, the controversial status of connective tissue disorders and in the absence of concomitant disease, open repair was indicated. There was no proof of a mycotic plaque or connective tissue disease in the microbiological-, pathological analysis and at electron-microscopy. The patient was discharged on the thirteenth postoperative day. In spite of good preliminary results of TEVAR in PAU, in selective cases there is still an indication for open surgery.

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Carotid endarterectomy in patients with foetal-type posterior circle of Willis: Is there an indication for local anaesthesia?

VASA ◽

10.1024/0301-1526/a000138 ◽

2011 ◽

Vol 40 (5) ◽

pp. 404-407

Author(s):

Maras ◽

Tzormpatzoglou ◽

Papas ◽

Papanas ◽

Kotsikoris ◽

...

Keyword(s):

Carotid Endarterectomy ◽

Local Anaesthesia ◽

Anatomical Variation ◽

Anatomical Variations ◽

Circle Of Willis ◽

Variable Degree ◽

Operative Complications ◽

The Right ◽

Ica Stenosis ◽

Symptomatic Stenosis

Foetal-type posterior circle of Willis is a common anatomical variation with a variable degree of vessel asymmetry. In patients with this abnormality, carotid endarterectomy (CEA) may create cerebral hypo-perfusion intraoperatively, and this may be underestimated under general anaesthesia. There is currently no evidence that anatomical variations in the circle of Willis represent an independent risk factor for stroke. Moreover, there is a paucity of data on treating patients with such anatomical variations and co-existing ICA stenosis. We present a case of CEA under local anaesthesia (LA) in a 52-year-old female patient with symptomatic stenosis of the right ICA and coexistent foetal-type posterior circle of Willis. There were no post-operative complications and she was discharged free from symptoms. She was seen again 3 months later and was free from complications. This case higlights that LA should be strongly considered to enable better intra-operative neurological monitoring in the event of foetal-type posterior circle of Willis.

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