Abstract Details

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

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P7 - Poster Session 7 (8:00 AM-9:00 AM)

Poster/Presentation
Number 6-027

Objective We sought to determine the association between circle of Willis (CoW) anatomical variations and outcomes in aneurysmal subarachnoid hemorrhage (aSAH) patients.

Background The impact of CoW anatomical variations on vasospasm risk and functional outcome in patients with aSAH is poorly understood.

Design/Methods We performed a retrospective study on a single center cohort of patients with aSAH admitted to an academic center between 2015 and 2022. After reviewing imaging, we classified CoW variants into 4 categories: 1) incomplete anterior segments if either proximal anterior cerebral or anterior communicating arteries were absent or hypoplastic (with a 1mm diameter cutoff), 2) incomplete posterior segments if posterior communicating or proximal posterior cerebral arteries were absent or hypoplastic; 3) complete CoW; 4) others. Outcomes include vasospasm based on transcranial Doppler (TCD) criteria and poor functional outcome defined as modified Rankin Scale 4-6 at 3 months post discharge. Binary logistic regression analysis was used to test the association of each CoW variant with outcomes.

Results We included 178 patients with aSAH (mean age 55.9 years [SD 13.6], 56% female). Eighty percent of patients had incomplete CoW and they were older than those with complete CoW (mean age 57.4 [SD12.7] vs 49.9 [15.4]; p=0.003). Incomplete posterior segments were seen in 73% of patients. The presence of incomplete anterior segments was more common in females (11% vs 1%; p=0.01) and it was associated with vasospasm (OR 2.39, 95% CI 1.02-5.63; p=0.042), but not with poor functional outcome (p=0.89). There was no association between incomplete posterior segments and vasospasm risk (p=0.29) or poor functional outcome (p=0.93).

Conclusions Anatomical variations of the CoW may affect TCD findings but did not appear to be associated with poor outcomes. Larger prospective studies are needed to explore clinical significance of CoW variants in aSAH patients.

Authors/Disclosures
Scott Moody PRESENTER	No disclosure on file
John Pham	Mr. Pham has nothing to disclose.
	No disclosure on file
Ariyaporn Haripottawekul	Miss Haripottawekul has nothing to disclose.
Thanujaa Subramaniam, MD (Brown Neurology)	Dr. Subramaniam has nothing to disclose.
Michael Reznik, MD (Rhode Island Hospital)	Dr. Reznik has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Morrison Mahoney. The institution of Dr. Reznik has received research support from NIDUS.
Karen L. Furie, MD (RIH/Alpert Medical School of Brown Univ)	The institution of Dr. Furie has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Janssen/BMS. Dr. Furie has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for BMJ/JNNP. The institution of Dr. Furie has received research support from NINDS.
Shadi Yaghi, MD (Hackensack Meridian Health)	Dr. Yaghi has nothing to disclose.
Ali Mahta, MD (Brown University)	Dr. Mahta has received research support from Brown University Health.

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