Research Progress of the Correlation between Variation in the Circle of Willis and Ischemic Stroke

doi:10.3969/j.issn.1673-5765.2024.02.014

Abstract

Abstract: In the evaluation of autopsy and MRA technology, researchers have identified variations in the circle of Willis and classified them into different types. Based on MRA technology, the circle of Willis can be divided into four types according to the diameter of the arterial segment. Studies have revealed that different types of circle of Willis are associated with the onset, location, and recurrence of ischemic stroke. However, the correlation between different types of circle of Willis and the severity and prognosis of ischemic stroke remains controversial. This paper provides a comprehensive review on the correlation between variation in the circle of Willis and ischemic stroke.

Key words: Circle of Willis; Ischemic stroke; Collateral circulation

摘要： 通过尸体解剖和MRA等影像学技术，学者们发现Willis环存在变异，并将其分为不同类型。依托MRA技术，根据Willis环不同动脉段直径大小，可将Willis环分为4种类型。研究发现不同类型的Willis环与缺血性卒中的发病、发生部位及复发有关，然而不同类型的Willis环与缺血性卒中的严重程度及预后的相关性存在一定的争议。本文就Willis环变异与缺血性卒中的相关性进行综述。

关键词: Willis环; 缺血性卒中; 侧支循环

CLC Number:

ZENG Chaokun, ZHAO Zhenqiang. Research Progress of the Correlation between Variation in the Circle of Willis and Ischemic Stroke[J]. Chinese Journal of Stroke, 2024, 19(2): 213-218.

曾潮坤, 赵振强. Willis环变异与缺血性卒中相关性的研究进展[J]. 中国卒中杂志, 2024, 19(2): 213-218.

References

[1] 马风伟，邓青芳. 缺血性脑卒中病理生理机制及治疗对策研究进展[J]. 贵州师范大学学报（自然科学版），2022，40（6）：116-122.
MA F W，DENG Q F. Review on signaling pathways in ischemic stroke and their therapeutic strategies[J]. Journal of Guizhou Normal University Natural Sciences，2022，40（6）：116-122.
[2] 张柳英，夏章勇，赵鑫，等. 缺血性脑卒中侧支循环的研究进展[J]. 中华老年心脑血管病杂志，2018，20（7）：777-780.
ZHANG L Y，XIA Z Y，ZHAO X，et al. Research progress of collateral circulation in ischemic stroke[J]. Chinese Journal of Geriatric Heart Brain and Vessel Diseases，2018，20（7）：777-780.
[3] LIU L P，DING J，LENG X Y，et al. Guidelines for evaluation and management of cerebral collateral circulation in ischaemic stroke 2017[J]. Stroke Vasc Neurol，2018，3（3）：117-130.
[4] BENDER M，OLIVI A，TAMARGO R J. Iulius Casserius and the first anatomically correct depiction of the circulus arteriosus cerebri（of Willis）[J]. World Neurosurg，2013，79（5/6）：791-797.
[5] VRSELJA Z，BRKIC H，MRDENOVIC S，et al. Function of circle of Willis[J]. J Cereb Blood Flow Metabo，2014，34（4）：578-584.
[6] DUMITRESCU A M，EVA L，HABA D，et al. Anatomical study of circle of Willis on fresh autopsied brains. A study of a Romanian population[J]. Rom J Morphol Embryol，2022，63（2）：395-406.
[7] OROSZ L，GYÖNGYÖSI Z，SUSÁN Z，et al. Assessment of malformations，variations and diameters of vessels forming the circle of Willis—an autopsy study in a non-cerebrovascular cohort[J]. Transl Neurosci，2022，13（1）：398-406.
[8] HINDENES L B，HÅBERG A K，JOHNSEN L H，et al. Variations in the circle of Willis in a large population sample using 3D TOF angiography：the TROMSØ study[J/OL]. PLoS One，2020，15（11）：e0241373[2023-05-06]. https://doi.org/10.1371/journal.pone.0241373.
[9] KıZıLGÖZ V，KANTARCı M，KAHRAMAN Ş. Evaluation of circle of Willis variants using magnetic resonance angiography[J/OL]. SciRep，2022，12（1）：17611[2023-05-06]. https://doi.org/10.1038/s41598-022-21833-w.
[10] ALPERS B J，BERRY R G. Circle of Willis in cerebral vascular disorders. The anatomical structure[J/OL].
Arch Neurol，1963，8：398-402[2023-05-06].
https://doi.org/10.1001/archneur.1963.00460040068006.
[11] LAZORTHES G，GOUAZE A，SANTINI J J，et al. Le cercle artériel du cerveau（circulus arteriosus cerebri）[J/OL]. Anatomia Clinica，1979，1：241-257[2023-05-06]. https://doi.org/10.1007/BF01654581.
[12] EFTEKHAR B，DADMEHR M，ANSARI S，et al. Are the distributions of variations of circle of Willis different in different populations? - Results of an anatomical study and review of literature[J/OL]. BMC Neurol，2006，6：22[2023-05-06]. https://doi.org/10.1186/1471-2377-6-22.
[13] HARTKAMP M J，van Der GROND J，van EVERDINGEN K J，et al. Circle of Willis collateral flow investigated by magnetic resonance angiography[J]. Stroke，1999，30（12）：2671-2678.
[14] ZHOU H S，SUN J，JI X T，et al. Correlation between the integrity of the circle of Willis and the severity of initial noncardiac cerebral infarction and clinical prognosis[J/OL]. Medicine（Baltimore），2016，95（10）：e2892[2023-05-06]. https://doi.org/10.1097/md.0000000000002892.
[15] TOM V S，HENDRIKSE J，BIESSELS G J，et al. Completeness of the circle of Willis and risk of ischemic stroke in patients without cerebrovascular disease[J]. Neuroradiology，2015，57（12）：1247-1251.
[16] OUMER M，ALEMAYEHU M，MUCHE A. Association between circle of Willis and ischemic stroke：a systematic review and meta-analysis
[J/OL]. BMC Neurosci，2021，22（1）：3[2023-05-06].
https://doi.org/10.1186/s12868-021-00609-4.
[17] SHAHAN C P，GRAY R I，CROCE M A，et al. Impact of circle of Willis anatomy in traumatic blunt cerebrovascular injury-related stroke[J/OL]. Trauma Surg Acute Care Open，2017，2（1）：e000086[2023-05-06]. https://doi.org/10.1136/tsaco-2017-000086.
[18] den HEIJER，RUITENBERG A，BAKKERJ，et al. Bilateral caudate nucleus infarction associated with variant in circle of Willis[J/OL]. BMJ Case Rep，2009：bcr2006112656[2023-05-06]. https://doi.org/10.1136/bcr.2006.112656.
[19] ANELLO M G，MIAO T L，PANDEY S K，et al. Rare bilateral caudate infarction in a patient with a common circle of willis variant[J]. Can J Neurol Sci，2019，46（5）：593-594.
[20] POPOVA E N，VISHNIAKOVA M V，MARATKANOVA T V，et al. Characteristics of ischemic stroke in patients with congenital anomalies of the circle of Willis[J]. Zh Nevrol Psikhiatrii Im S S Korsakova，2011，111（8 Pt 2）：9-14.
[21] de CARO J，CIACCIARELLI A，TESSITORE A，et al. Variants of the circle of Willis in ischemic stroke patients[J]. J Neurol，2021，268（10）：3799-3807.
[22] KIM K M，KANG H S，LEE W J，et al. Clinical significance of the circle of Willis in intracranial atherosclerotic stenosis[J]. J Neurointerv Surg，2016，8（3）：251-255.
[23] PARK B J，KIM K M，LEE W J，et al. Clinical significance of the circle of willis in patients with symptomatic internal carotid artery occlusion[J/OL]. World Neurosurg，2018，115：e585-e591[2023-05-06]. https://doi.org/10.1016/j.wneu.2018.04.104.
[24] ZHANG B，WANG G L S，GAO Y，et al. Influence of the integrity of circle of Willis on asymptomatic or mild patients with first diagnosed chronic internal carotid artery occlusion[J/OL]. Euro J Radio，2023，165：110954[2023-05-06]. https://doi.org/10.1016/j.
ejrad.2023.110954.
[25] WESTPHAL L P，LOHAUS N，WINKLHOFER S，et al. Circle of Willis variants and their association with outcome in patients with middle cerebral artery-M1-occlusion stroke[J]. Euro J Neurol，2021，28（11）：3682-3691.
[26] LIN E，KAMEL H，GUPTA A，et al. Incomplete circle of Willis variants and stroke outcome
[J/OL]. Eur J Radiol，2022，153：110383[2023-05-06]. https://doi.org/10.1016/j.ejrad.2022.110383.
[27] HONG J M，CHOI J Y，LEE J H，et al. Impact of posterior communicating artery on basilar artery steno-occlusive disease[J]. J Neurol Neurosurg Psychiatry，2009，80（12）：1390-1393.
[28] CHUANG Y M，CHAN L，LAI Y J，et al. Configuration of the circle of Willis is associated with less symptomatic intracerebral hemorrhage in ischemic stroke patients treated with intravenous thrombolysis[J]. J Crit Care，2013，28（2）：166-172.
[29] 刘相城，黄菊华，刘春柏，等. Willis环完整性与急性缺血性脑卒中静脉溶栓早期疗效的相关性[J]. 中国老年学杂志，2022，42（11）：2628-2630.
LIU X C，HUANG J H，LIU C B，et al. Association of Willis circle integrity with early efficacy of intravenous thrombolysis in acute ischemic stroke[J]. Chinese Journal of Gerontology，2022，42（11）：2628-2630.
[30] 郭建军，吴小燕，倪晓俊，等. 急性缺血性脑卒中患者Willis环变异与静脉溶栓预后分析[J]. 岭南急诊医学杂志，2020，25（1）：55-57.
GUO J J，WU X Y，NI X J，et al. Circle of Willis variants and prognosis of patients with acute ischemic stroke treated with intravenous thrombolysis[J]. Lingnan Journal of Emergency Medicine，2020，25（1）：55-57.
[31] 张润声，吴小燕，郭建军，等. Willis环及脑白质变化对急性缺血性脑卒中静脉溶栓患者预后的影响[J]. 广东医学，2020，41（16）：1659-1663.
ZHANG R S，WU X Y，GUO J J，et al. Effects of the circle of Willis and white matter lesions on the prognosis of patients with acute ischemic stroke trea-ted with intravenous thrombolysis[J]. Guangdong Medical Journal，2020，41（16）：1659-1663.