THE SIGNIFICANCE OF LIFESTYLE, ASSOCIATED DISEASES, AND ANATOMICAL VARIANTS OF THE CIRCLE OF WILLIS IN THE FOR-MATION OF ANTERIOR COMMUNICATING ARTERY ANEURYSMS
Keywords:
CIRCLE OF WILLIS, ANTERIOR COMMUNICATING ARTERY ANEURYSM, ANATOMICAL VARIANTS, LIFESTYLEAbstract
Intracranial aneurysm represent a cerebrovascular disease with a relatively low incidence, but among these the most common are aneurysms developed in the anterior part of the circle of Willis (CoW). Material and methods: We collected the demographic and morphological data of the patients admitted in “Prof. Dr. N. Oblu” Emergency Clinical Hospital, Iași, Romania, with ruptured AcomA aneurysms, who later deceased and were autopsied in the Pathology Department of the same hospital, over a period of 6 years (January 2014 to December 2019), and analyzed data related to: age, gender, lifestyle (heavy smoking and alcoholism), type of anatomical variant of circle of Willis, and presence of any associated diseases. Results: We identified 7 patients with ruptured AComA aneurysm. 57.14% were male patients. The average age was 60.85 (range 34 to 69). Left posterior communicating artery (PcomA) was hypoplastic in 100% of all deceased patients. Right PComA presented hypoplasia (71.42%) or fetal type variant (28.57%). 71.42% of all cases showed anatomical variants both in the anterior and the posterior part of CoW. 66% of the female patients with AComA aneurysm presented obesity, type 2 diabetes, atherosclerotic disease and hypertension. 100% of male patients presented hypertension and atherosclerotic disease, 75% of them were chronic alcohol consumers and 50% were heavy smokers. Conclusions: The lifestyle, associated diseases, and anatomical variants of the component arteries of the circle of Willis, both from its anterior and posterior parts, could be risk factors for the formation of anterior communicating artery aneurysm.
References
2. Stojanović NN, Kostić A, Mitić R, Berilažić L, Radisavljević M. Association between Circle of Willis Configuration and Rupture of Cerebral Aneurysms. Medicina (Kaunas) 2019; 55(7): 338 / doi: 10.3390/ medicina55070338.
3. Jersey AM, Foster DM. Cerebral Aneurysm. In: StatPearls [Internet], Treasure Island (FL): StatPearls Publishing; 2023. https://www.ncbi.nlm.nih.gov/books/NBK430685/
4. Castro MA, Putman CM, Sheridan MJ, Cebral JR. Hemodynamic Patterns of Anterior Communicating Artery Aneurysms: A Possible Association with Rupture. AJNR Am J Neuroradiol 2009; 30: 297-302.
5. Chen J, Li M, Zhu X, et al. Anterior Communicating Artery Aneurysms: Anatomical Considerations and Microsurgical Strategies. Front Neurol 2020; 11: 1020 / doi: 10.3389/fneur.2020.01020.
6. Yilmaz A, Özkul A. Anatomical variations of anterior circulation in the brains of patients with and without intracranial aneurysm. Türk Beyin Damar Hast Der 2018; 24(1): 8-13.
7. Kirgis HD, Fisher WL, Llewellyn RC, Peebles EMcc. Aneurysms of the Anterior Communicating Artery and Gross Anomalies of the Circle of Willis. J Neurosurg 1966; 25(1): 73-78.
8. Fréneau M, Baron-Menguy C, Vion AC, Loirand G. Why Are Women Predisposed to Intracranial Aneurysm? Front Cardiovasc Med 2022; 9: 815668 / doi: 10.3389/fcvm. 2022.815668.
9. Nishio A, Sakaguchi M, Murata K, et al. Anterior communicating artery aneurysm in early childhood. Report of a case. Surg Neurol 1991; 35(3): 224-229.
10. Padget D. The circle of Willis: its embryology and anatomy. In: W Dandy editor. Intracranial arterial aneurysms. New York: Comstock Publishing 1944, 67- 90.
11. Kwak R, Ohi T, Niizuma H, Suzuki J. Hemodynamics in the anterior part of the circle of Willis in patients with the anterior communicating artery aneurysm-a study by cerebral angiography. No Shinkei Geka 1978; 6(11): 1065-1069.
12. Charbel FT, Seyfried D, Mehta B, Dujovny M, Ausman JI. Dominant A1: angiographic and clinical correlations with anterior communicating artery aneurysms. Neurol Res 1991; 13(4): 253-256.
13. Tarulli E, Fox AJ. Potent risk factor for aneurysm formation: termination aneurysms of the anterior communicating artery and detection of A1 vessel asymmetry by flow dilution. AJNR Am J Neuroradiol 2010; 31(7): 1186-1191.
14. Rinaldo L, McCutcheon BA, Murphy ME, Bydon M, Rabinstein AA, Lanzino G. Relationship of A1 segment hypoplasia to anterior communicating artery aneurysm morphology and risk factors for aneurysm formation. J Neurosurg 2017; 127(1): 89-95.
15. van Kammen MS, Moomaw CJ, van der Schaaf IC, et al. Heritability of circle of Willis variations in families with intracranial aneurysms. PLOS ONE 2018; 13(1): e0191974.
16. Kaya V, Tahtabasi M, Yıldırım İO. Risk factors for the rupture of anterior communicating artery aneu-rysms: Coexistence of fetal-type posterior cerebral artery and A1 segment hypoplasia/agenesis. J Clin Neurosci 2023; 110: 74-79.
17. Davidoiu AM, Minca DI, Rusu MC, Hostiuc S, Toader C. The Fetal Type of Posterior Cerebral Artery. Medicina 2023; 59: 231 / doi: 10.3390/medicina59020231.
18. Iqbal S. A comprehensive study of the anatomical variations of the circle of Willis in adult human brains. J Clin Diagn Res 2013; 7(11): 2423-2427.
19. Shaban A, Albright KC, Boehme AK, et al. Circle of Willis Variants: Fetal PCA. Stroke Res Treat 2013; 105937 / doi: 10.1155/2013/105937.
20. Inagawa T, Hirano A. Ruptured intracranial aneurysms: an autopsy study of 133 patients. Surg Neurol 1990; 33(2): 117-123.
21. Permiakov NK, Negretskiĭ AP, Krylov VV, Miatchin MI, Saenko AV. Cerebral artery aneurysms: Clinico-anatomic analysis of 610 cases. Arkh Patol 1993; 55(4): 10-16.
22. Park SK, Kim JM, Kim JH, Cheong JH, Bak KH, Kim CH. Aneurysms subarachnoid hemorrhage in young adults: a gender comparison study. J Clin Neurosci 2008; 15: 389-392.
23. Ghods AJ, Lopes D, Chen M. Gender Differences in Cerebral Aneurysm Location. Front Neurol 2012; 3: 78 / doi: 10.3389/fneur.2012.00078.
24. Yoshida Y, Tochinai H, Murakami M, Murakami T, Saiki I, Kanaya H. A case of absence of the left internal carotid artery associated with aneurysm of the anterior communicating artery. No Shinkei Geka 1988; 16(9): 1089-1094.
25. Nakai H, Kawata Y, Aizawa S, Tanaka T, Yonemasu Y. Unilateral agenesis of the internal carotid artery in a patient with ruptured aneurysm of the anterior communicating artery; a case report. No Shinkei Geka 1992; 20(8): 893-898.
26. Aydin IH, Takçi E, Kadioğlu HH, Tüzün Y, Kayaoğlu CR, Barlas E. Vascular variations associated with anterior communicating artery aneurysms-an intraoperative study. Minim Invasive Neurosurg 1997; 40(1): 17-21.
27. Bazowski P, Ladziński P, Gamrot J, Rudnik A, Baron J. Aneurysms of the anterior communicating artery and anomalies of the anterior part of the circle of Willis. Neurol Neurochir Pol 1991; 25(4): 485-490.
28. Krzyzewski RM, Tomaszewska IM, Lorenc N, et al. Variations of the anterior communicating artery complex and occurrence of anterior communicating artery aneurysm: A2 segment consideration. Folia Med Cracov 2014; 54(1): 13-20.
29. Shadad M, Balaha A, Ganna A. Anterior Communicating Artery Complex Anatomy and its Correlation with Aneurysm Formation. Med J Cairo Univ 2021; 89(6): 2397-2402.
30. Alawamry AME, Taha MM, Abdelbary TH, Bessar AA, Farid M. Role of preoperative computed tomography angiographic anatomical considerations and their intraoperative interpretations in prediction of outcome in microsurgical clipping of ruptured anterior communicating aneurysm. Egypt J Neurosurg 2021; 36(1): 5 / doi: 10.1186/s41984-021-00103-3.
31. Rinkel GJE. Natural history, epidemiology and screening of unruptured intracranial aneurysms. Rev Neurol (Paris) 2008; 164(10): 781-786.
32. La Sala L, Prattichizzo F, Ceriello A. The link between diabetes and atherosclerosis. Eur J Prev Cardiol 2019; 26(2_suppl): 15-24.
33. Guzik TJ, Touyz RM. Vascular pathophysiology of hypertension. In: R Krams, M Bäck editors. The ESC Textbook of Vascular Biology, Oxford: Oxford University Press, 2017, 291-308.
34. Powell-Wiley TM, Poirier P, Burke LE, et al. Obesity and Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation 2021; 143(21): e984-e1010.
35. Juvela S, Porras M, Poussa K. Natural history of unruptured intracranial aneurysms: probability and risk factors for aneurysm rupture. Neurosurg Focus 2000; 93(3): 379-387.
36. Bennett P, de Aguiar GB, da Silva RC. The relationship between smoking and brain aneurysms: from formation to rupture. Rev Assoc Med Bras 2021; 67(6): 895-899.
Additional Files
Published
Issue
Section
License
COPYRIGHT
Once an article is accepted for publication, MSJ requests a transfer of copyrights for published articles.
COPYRIGHT TRANSFER FORM FOR
REVISTA MEDICO-CHIRURGICALĂ A SOCIETĂȚII DE MEDICI ȘI NATURALIȘTI DIN IAȘI /
THE MEDICAL-SURGICAL JOURNAL OF THE SOCIETY OF PHYSICIANS AND NATURALISTS FROM IASI
We, the undersigned authors of the manuscript entitled
_____________________________________________________________________________________
_____________________________________________________________________________________
warrant that this manuscript, which is submitted for publication in the REVISTA MEDICO-CHIRURGICALĂ, has not been published and it is not under consideration for publication in another journal.
- we give the consent for publication in the REVISTA MEDICO-CHIRURGICALĂ, in printed and electronic format and we transfer unconditioned and complete the copyright of this manuscript to the REVISTA MEDICO-CHIRURGICALĂ, in the event of its acceptance.
- the manuscript does not break the intellectual property rights of any other person.
- we have read the submitted version of the manuscript and we are fully responsible for the content.
Names and signatures of authors / copyright owners (the following sequence is the authorship of the article):
- ______________________________/_________________________
- ______________________________/_________________________
- ______________________________/_________________________
N.B. All the authors must sign this form