ArticleSurgical and radiologic anatomy : SRA2021
Morphologic variants of the Cerebral Arterial Circle on computed tomographic angiography (CTA): a large retrospective study.
Article in Surgical and radiologic anatomy : SRA, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
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11 citing papers in PubMed, 1 synthesis or guideline pooled it, 15 citations in OpenAlex.
- Anatomic variations in basilar artery termination: a systematic review and meta-analysis with presentation of an illustrative case.Surgical and radiologic anatomy : SRA · 2026Pooled it
- An unusual variant of the anterior cerebral and anterior communicating arterial system: anatomical description with clinical and radiological implications.Surgical and radiologic anatomy : SRA · 2026Article
- A rare coexistence of hypoplasia of the middle cerebral artery with aortic arch origin of the vertebral artery: a case report and analysis of hemodynamic vulnerability.BMC neurology · 2026Article
- Cerebrovascular morphology: Insights into normal variations, aging effects and disease implications.Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism · 2025Review
- Article
- Thrombectomy for Posterior Communicating Artery Occlusion: Report of an Extremely Rare Case, Review, and Technical Nuance.NMC case report journal · 2025Article
- Anatomical evaluation of P1 segment of posterior cerebral artery and posterior communicanting artery in 340 human hemispheres: a proposal for morphological classification.Surgical and radiologic anatomy : SRA · 2024Article
- Acute tandem occlusion stroke in internal carotid artery and fetal posterior cerebral artery: endovascular management.Revista de neurologia · 2023Article
- The Fetal Type of Posterior Cerebral Artery.Medicina (Kaunas, Lithuania) · 2023Article
- Prevalence and Incidence of Carotid-Fetal-Posterior Syndrome.Cerebrovascular diseases (Basel, Switzerland) · 2023Article
- An extremely short posterior communicating artery diagnosed by magnetic resonance angiography.Surgical and radiologic anatomy : SRA · 2022Article
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Abstract
purposeTo confirm and illustrate the great variability of morphology of the Cerebral Arterial Circle (CAC)-also commonly called "Circle of Willis"-in current clinical Computed Tomography Angiography (CTA) practice.
methodsComputed Tomographic Angiographic 3D Volume Rendering reconstructions of the CAC performed in a series of 511 patients were retrospectively reviewed and classified following their anatomic configuration.
resultsAn amount of 27 CAC configurations were listed. Complete and "nearly complete" (1 missing segment) CACs were found in 115 (22.58%) and 157 (28.6%) patients. The posterior arch was much more frequently incomplete (374 patients = 73.18%) than the anterior arch (96 patients = 18.4%). The main cause was a high prevalence of missing posterior communicating arteries (PCoAs). The left or right PCoA were unilaterally lacking in 156 patients (30.53%) and both PCoAs were lacking in 179 patients (35.02%). Cases with 2 and 3 missing segments were observed in 184 (36%) and 44 patients (8.6%). Precarious situations were also identified including 7 cases (1.4%) of complete isolation of the middle cerebral artery (MCA), 11 cases (2.15%) of absence of interhemispheric supply, 205 cases (40.1%) of full separation of the carotid and vertebra-basilar (VB) territories and 44 cases (8.6%) of full separation of the three main arterial axes (both ICAs and VB). The prevalence of Fetal Posterior Cerebral Arteries (FPCA) variants was also reported. A "Full" FPCA was found unilaterally in 48 (9.4%) and bilaterally in 13 (2.54%) of patients. Apart from agenesis and hypoplasia reported in our study, various other variations of the anterior complex of the CAC (ACoA and A2 segments of the ACA) were also noted.
conclusionCTA with 3D Volume Rendering may powerfully assess the numerous variations of the CAC. This assessment is of prime importance for the evaluation of patients presenting with risk factors or in whom neurosurgery, cardiac surgery, interventional radiology or carotid endarterectomy (CEA) are being considered.
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