Evidence map›Paper›PMID 41430518›Full record

ArticleNeurocritical care2026

Impact of Circle of Willis Anatomical Variations on Outcomes in Aneurysmal Subarachnoid Hemorrhage.

Carlin Chuck, Mazen Taman, Scott Moody, Evrim Ozcan, John Pham, Abigail Abraham Teshome, Joshua Feler, Dylan Wolman, Mahesh Jayaraman, Krisztina Moldovan and 3 more

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Article in Neurocritical care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

13 authors.

Carlin ChuckThe Warren Alpert School of Medicine at Brown University, Providence, RI, USA.
Mazen TamanThe Warren Alpert School of Medicine at Brown University, Providence, RI, USA.
Scott MoodyBrigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Evrim OzcanThe Warren Alpert School of Medicine at Brown University, Providence, RI, USA.
John PhamThe Warren Alpert School of Medicine at Brown University, Providence, RI, USA.
Abigail Abraham TeshomeThe Warren Alpert School of Medicine at Brown University, Providence, RI, USA.
Joshua FelerThe Warren Alpert School of Medicine at Brown University, Providence, RI, USA.
Dylan WolmanThe Warren Alpert School of Medicine at Brown University, Providence, RI, USA.
Mahesh JayaramanThe Warren Alpert School of Medicine at Brown University, Providence, RI, USA.
Krisztina MoldovanThe Warren Alpert School of Medicine at Brown University, Providence, RI, USA.
Radmehr TorabiThe Warren Alpert School of Medicine at Brown University, Providence, RI, USA.
Karen L FurieThe Warren Alpert School of Medicine at Brown University, Providence, RI, USA.
Ali MahtaThe Warren Alpert School of Medicine at Brown University, Providence, RI, USA. ali_mahta@brown.edu.ORCID 0000-0001-8518-8783

Funding

NHLBI Division of Intramural Research HL094308
6 · The paper itself

Abstract

backgroundAnatomical variations in the Circle of Willis (CoW) may influence hemodynamics and aneurysmal subarachnoid hemorrhage (aSAH) outcomes. We hypothesized that incomplete CoW could alter cerebral blood flow and reduce symptomatic vasospasm risk due to underlying arteriosclerotic changes.

methodsWe analyzed imaging data from patients with aSAH admitted to an academic center from 2015-2022. Patients were categorized by CoW anatomy into two (complete vs. incomplete) and three groups (complete, partial [missing an anterior or posterior component], and disconnected [missing both an anterior and posterior component]). Primary outcomes included radiologic vasospasm (transcranial Doppler [TCD] criteria) and symptomatic vasospasm. Secondary outcomes included delayed cerebral ischemia and three-month functional outcomes (modified Rankin Scale).

resultsAmong 286 patients with aSAH (61.5% female; mean age 56.2 ± 13.4 years), 79% had incomplete CoW anatomy and were older than complete CoW patients (57.6 ± standard deviation vs. 50.7 ± standard deviation years, P = 0.003). Univariate analysis revealed lower incidence of symptomatic vasospasm in incomplete CoWs (36% vs. 59%, P = 0.013) without significant differences in TCD-diagnosed vasospasm or functional outcomes. Multivariate analysis confirmed incomplete and disconnected CoWs were associated with lower symptomatic vasospasm risk (odds ratio [OR] 0.43, 95% confidence interval [CI] 0.19-0.93, P = 0.03 and OR 0.27, 95% CI 0.10-0.68, P = 0.007, respectively) with no differences in TCD elevation, delayed cerebral ischemia, or three-month functional outcomes (OR 1.01, 95% CI 0.5-2.0 and OR 0.87, 95% CI 0.37-2.07, respectively).

conclusionsIncomplete CoW is associated with lower symptomatic vasospasm risk but not with functional outcomes. These findings may reflect physiological arteriosclerotic changes influencing vasospasm risk. Understanding CoW anatomy could assist risk stratification of patients with aSAH, warranting further research into these mechanisms.

Indexed as

Brain IschemiaCircle of WillisSubarachnoid HemorrhageVasospasm, IntracranialAdultAgedFemaleHumansMaleMiddle AgedRetrospective StudiesUltrasonography, Doppler, TranscranialAneurysmal subarachnoid hemorrhageCircle of willisCircle of willis variationsIncomplete CoW anatomySymptomatic vasospasmVasospasm risk factors

Identifiers

PMID41430518

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