![]() These changes can be divided into two main phenomena: (1) in the AComA circulation, a patient with a of hypoplastic or reduced-caliber A1-ACA, can increase the caliber of this vessel in response to having the contralateral ACA segment A1 and A2 covered by the flow diverter. We have presented five patients that demonstrate different patterns of arterial remodeling of the circle of Willis vessels in adult patient response to flow diversion. ![]() Keywords: Circle of Willis, Flow diversion, Intracranial aneurysms, Vascular remodeling 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. ![]() 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.Ĭonclusion: The use of FDS can affect vessels covered by the device and other arteries of the circle of Willis adjacent to the FDS. 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. 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 one of the cases, this led to the filling of the aneurysm and required placement of coils within the lesion which was curative. The observed changes provide a paradigm of how flow change can institute anatomic changes in the adult circle of Willis vasculature.Ĭase 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. Rafael Trindade Tatit, Department of Medicine, Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil.ĭOI:10.25259/SNI_1139_2022Copyright: © 2023 Surgical Neurology International 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.īackground: 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). Department of Interventional Neuroradiology, Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil.Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, United States,. ![]() Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA,.Department of Medicine, Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil,.Article Type: Rafael Trindade Tatit 1, Christopher S. ![]()
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