Examining Atherosclerosis Patterns in the Circle of Willis: A Case Study of Duplicated Anterior Communicating Artery

The anterior communicating artery (ACoA) plays a pivotal role in maintaining cerebral hemodynamics, as its diameter is a major determinant of blood collateralization through the circle of Willis following internal carotid artery occlusion. While variations of this artery are not uncommon, data on their clinicopathologic relevance are limited. In this report, we present our observation from a fresh cadaver of a male individual who had succumbed to cardiac causes. The circle of Willis displayed a duplicated ACoA with atherosclerosis that predominantly affected the posterior horn while sparing the anterior horn. The anterior horn was characterized by its shorter length and larger diameter compared to the posterior horn. The paper focuses on elucidating the microsurgical anatomy of this particular ACoA variant and exploring potential mechanisms that may underlie the pattern of atherosclerotic distribution within the circle of Willis. Based on this report, while further evidence is needed for confirmation, it is plausible that the existence of a duplicated ACoA may offer a protective mechanism, ensuring uninterrupted collateral circulation in the event of a blockage in one of the horns. Further analysis of the ACoA and its pattern of involvement in intracranial atherosclerosis is warranted, as the atherosclerotic patterns in this region hold clinical and pathological significance.