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Plasticity of the adult circle of Willis in response to flow diversion stents

BACKGROUND: We present five patients with remodeling of the adult circle of Willis in response to flow diverter stents (FDSs) at the anterior communicating artery (AComA) and the posterior communicating artery (PComA). The observed changes provide a paradigm of how flow change can institute anatomic...

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Autores principales: Tatit, Rafael Trindade, Ogilvy, Christopher S., Shutran, Max S., Tawk, Rabih G., Yasuda, Thomas A., Baccin, Carlos Eduardo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Scientific Scholar 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9990810/
https://www.ncbi.nlm.nih.gov/pubmed/36895205
http://dx.doi.org/10.25259/SNI_1139_2022
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author Tatit, Rafael Trindade
Ogilvy, Christopher S.
Shutran, Max S.
Tawk, Rabih G.
Yasuda, Thomas A.
Baccin, Carlos Eduardo
author_facet Tatit, Rafael Trindade
Ogilvy, Christopher S.
Shutran, Max S.
Tawk, Rabih G.
Yasuda, Thomas A.
Baccin, Carlos Eduardo
author_sort Tatit, Rafael Trindade
collection PubMed
description BACKGROUND: We present five patients with remodeling of the adult circle of Willis in response to flow diverter stents (FDSs) at the anterior communicating artery (AComA) and the posterior communicating artery (PComA). The observed changes provide a paradigm of how flow change can institute anatomic changes in the adult circle of Willis vasculature. CASE DESCRIPTION: In the first two cases, after placement of the FDS covering the AComA, there was an increase in size and flow of the contralateral A1-anterior cerebral artery which had previously been hypoplastic. In one of the cases, this led to the filling of the aneurysm and required placement of coils within the lesion which was curative. In case three, the FDS effect led to asymptomatic occlusion of the PComA and associated aneurysm without change of the ipsilateral P1-segement of posterior-cerebral-artery (P1-PCA) caliber. In the fourth case, the FDS covering an aneurysm with a fetal PCA arising from its neck resulted in significant reduction of the aneurysm size, persistent flow and caliber of the fetal PCA, and the hypoplastic ipsilateral P1-PCA. Finally, in the fifth case, after FDS occlusion of the PComA and aneurysm there was increasement in diameter of the ipsilateral P1-PCA that was previously hypoplastic. CONCLUSION: The use of FDS can affect vessels covered by the device and other arteries of the circle of Willis adjacent to the FDS. The phenomena illustrated in the hypoplastic branches appear to be a compensatory response to the hemodynamic changes induced by the divertor and to the altered flow in the circle of Willis.
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spelling pubmed-99908102023-03-08 Plasticity of the adult circle of Willis in response to flow diversion stents Tatit, Rafael Trindade Ogilvy, Christopher S. Shutran, Max S. Tawk, Rabih G. Yasuda, Thomas A. Baccin, Carlos Eduardo Surg Neurol Int Case Report BACKGROUND: We present five patients with remodeling of the adult circle of Willis in response to flow diverter stents (FDSs) at the anterior communicating artery (AComA) and the posterior communicating artery (PComA). The observed changes provide a paradigm of how flow change can institute anatomic changes in the adult circle of Willis vasculature. CASE DESCRIPTION: In the first two cases, after placement of the FDS covering the AComA, there was an increase in size and flow of the contralateral A1-anterior cerebral artery which had previously been hypoplastic. In one of the cases, this led to the filling of the aneurysm and required placement of coils within the lesion which was curative. In case three, the FDS effect led to asymptomatic occlusion of the PComA and associated aneurysm without change of the ipsilateral P1-segement of posterior-cerebral-artery (P1-PCA) caliber. In the fourth case, the FDS covering an aneurysm with a fetal PCA arising from its neck resulted in significant reduction of the aneurysm size, persistent flow and caliber of the fetal PCA, and the hypoplastic ipsilateral P1-PCA. Finally, in the fifth case, after FDS occlusion of the PComA and aneurysm there was increasement in diameter of the ipsilateral P1-PCA that was previously hypoplastic. CONCLUSION: The use of FDS can affect vessels covered by the device and other arteries of the circle of Willis adjacent to the FDS. The phenomena illustrated in the hypoplastic branches appear to be a compensatory response to the hemodynamic changes induced by the divertor and to the altered flow in the circle of Willis. Scientific Scholar 2023-02-10 /pmc/articles/PMC9990810/ /pubmed/36895205 http://dx.doi.org/10.25259/SNI_1139_2022 Text en Copyright: © 2023 Surgical Neurology International https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Case Report
Tatit, Rafael Trindade
Ogilvy, Christopher S.
Shutran, Max S.
Tawk, Rabih G.
Yasuda, Thomas A.
Baccin, Carlos Eduardo
Plasticity of the adult circle of Willis in response to flow diversion stents
title Plasticity of the adult circle of Willis in response to flow diversion stents
title_full Plasticity of the adult circle of Willis in response to flow diversion stents
title_fullStr Plasticity of the adult circle of Willis in response to flow diversion stents
title_full_unstemmed Plasticity of the adult circle of Willis in response to flow diversion stents
title_short Plasticity of the adult circle of Willis in response to flow diversion stents
title_sort plasticity of the adult circle of willis in response to flow diversion stents
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9990810/
https://www.ncbi.nlm.nih.gov/pubmed/36895205
http://dx.doi.org/10.25259/SNI_1139_2022
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