Correlation between the flow pattern of the circle of Willis and segmental perfusion asymmetry after carotid artery
Y-M Chuang1, Y-J Chang, C-H Chang
1Department of Neurology, Far Eastern Memorial Hospital, Taipei, Taiwan.
Insights
Cerebral blood flow patterns after carotid stenting correlate with circle of Willis (CoW) anatomy. Altered CoW flow impacts regional cerebral blood volume (rCBV) in the corona radiata and basal ganglia.
Area of Science:
- Neurology
- Radiology
- Vascular Surgery
Background:
- Investigating cerebral perfusion and flow dynamics post-carotid revascularization.
- Understanding the role of the circle of Willis (CoW) in collateral circulation.
Purpose of the Study:
- To correlate cerebral perfusion and flow patterns with circle of Willis (CoW) anatomy after carotid artery revascularization.
- To assess the impact of carotid artery stenting (CAS) on cerebral hemodynamics.
Main Methods:
- Sixty-five patients with symptomatic carotid artery stenosis underwent MR angiography and perfusion imaging before and after CAS.
- Regions of interest (ROIs) analyzed included corona radiata (CR), centrum semiovale (CSO), occipital region (O), and basal ganglia (BA).
- Non-stented hemisphere served as internal control to evaluate interhemispheric indices.
Main Results:
- 47.6% of subjects showed altered CoW flow patterns post-CAS; 52.4% maintained static CoW configuration.
- A significant correlation was observed between relative cerebral blood volume (rCBV) interhemispheric index and CoW morphologic alterations.
- The altered CoW group exhibited higher rCBV interhemispheric indices in the CR and basal ganglia compared to the static group (P=0.03).
Conclusions:
- An association exists between regional cerebral blood volume (rCBV) interhemispheric asymmetry and CoW collateralization.
- The corona radiata (CR) demonstrates topographic significance in reflecting these hemodynamic changes, more so than the centrum semiovale (CSO).
Background:
To correlate cerebral perfusion and flow patterns after carotid artery revascularization within the circle of Willis (CoW).
Methods:
Sixty-five patients (male/female ratio: 38/27; mean age: 63.2±8.4years; range: 44-82years) with symptomatic carotid artery stenosis underwent magnetic resonance (MR) angiography and perfusion imaging prior to and after carotid artery stenting (CAS). Regions of interest (ROIs) on the MR perfusion maps included the corona radiata (CR), centrum semiovale (CSO), occipital region (O), and basal ganglia region (BA) in both stented and non-stented hemispheres. The non-stented hemisphere was used as internal control.
Results:
Subjects were assigned to the altered CoW group (N=31) vs. the static CoW group (N=34). Thirty-one subjects (47.6%) had an altered flow pattern in the CoW after CAS, and thirty-four (52.4%) retained a static CoW configuration. Relative cerebral blood volume (rCBV) interhemispheric index correlated with CoW morphologic alterations after carotid stenting. Altered CoW group had a higher regional interhemispheric index of rCBV in the CR (1.23±0.15 vs. 0.87±0.13; P=0.03) and basal ganglia (1.25±0.12 vs. 0.91±0.11; P=0.03) compared to the static group.
Conclusions:
An association between the regional cerebral blood volume (rCBV) interhemispheric asymmetry and CoW collateralization was observed. In addition, the CR, rather than CSO, was found to have topographic significance.
