Plasticity of circle of Willis: a longitudinal observation of flow patterns in the circle of Willis one week after stenting for severe internal carotid artery stenosis.

BACKGROUND AND PURPOSE: The purpose of the present study was to assess whether the direction of flow via the circle of Willis (CoW) changed after stenting for severe internal carotid artery (ICA) stenosis.

METHODS: 65 patients (38 men, mean age 63.2 +/- 8.4 years, range 44-82) with a symptomatic ICA occlusion were investigated. Magnetic resonance angiography was performed prior to and 1 week after carotid artery stenting (CAS). The pattern in the CoW was assessed.

RESULTS: One third of the subjects (35.38%) had a significantly altered flow pattern in the CoW after unilateral CAS, including blocked ipsilateral A1 segment collateral (n = 4), blocked contralateral A1 segment collateral (n = 5), blocked ipsilateral posterior communicating artery (PCoA) segment collateral (n = 4), blocked ipsilateral A1 segment and P1 segment collateral (n = 1), opening of ipsilateral A1 segment collateral (n = 5), opening of ipsilateral PCoA segment collateral (n = 3) and opening of ipsilateral P1 segment collateral (n = 1).

CONCLUSIONS: CoW segmental hypoplasia is not a static feature. Willisian collateralization with recruitment of the CoW segment (A1, P1 and PCoA) may be blocked after CAS. CAS also leads to the opening of new willisian collateralization, either for relief of reperfusion pressure or for other hypoperfused areas.