Anatomical variations of the circle of Willis and cerebrovascular accidents in transitional Albania

Aim: The purpose of this study was twofold: i) in a case-control design, to determine the relationship between anatomical variations of the circle of Willis and cerebrovascular accidents; ii) to assess the association between anatomical variations of the circle of Willis and aneurisms among patients with subarachnoid hemorrhage. Methods: A case-control study was conducted in Albania in 2013-2014, including 100 patients with subarachnoid hemorrhage and 100 controls (individuals without cerebrovascular accidents). Patients with subarachnoid hemorrhage underwent a CT angiography procedure, whereas individuals in the control group underwent a magnetic resonance angiography procedure. Binary logistic regression was used to assess the association between cerebrovascular accidents and the anatomical variations of the circle of Willis. Conversely, Fisher’s exact test was used to compare the prevalence of aneurisms between subarachnoid hemorrhage patients with and without anatomical variations of the circle of Willis. Results: Among patients, there were 22 (22%) cases with anatomical variations of the circle of Willis compared with 10 (10%) individuals in the control group (P=0.033). There was no evidence of a statistically significant difference in the types of the anatomical variations of the circle of Willis between patients and controls (P=0.402). In age- and-sex adjusted logistic regression models, there was evidence of a significant positive association between cerebrovascular accidents and the anatomical variations of the circle of Willis (OR=1.87, 95%CI=1.03-4.68, P=0.048). Within the patients’ group, of the 52 cases with aneurisms, there were 22 (42.3%) individuals with anatomical variations of the circle of Willis compared with no individuals with anatomical variations among the 48 patients without aneurisms (P<0.001). Conclusion: This study provides useful evidence on the association between anatomical variations of the circle of Willis and cerebrovascular accidents in transitional Albania. Furthermore, findings from this study confirm the role of the anatomical variations of the circle of Willis in the occurrence of cerebral aneurisms

Anatomical variations of the circle of Willis and cerebrovascular accidents in transitional Albania

Aim: The purpose of this study was twofold: i) in a case-control design, to determine the relationship between anatomical variations of the circle of Willis and cerebrovascular accidents; ii) to assess the association between anatomical variations of the circle of Willis and aneurisms among patients with subarachnoid hemorrhage.Methods: A case-control study was conducted in Albania in 2013-2014, including 100 patients with subarachnoid hemorrhage and 100 controls (individuals without cerebrovascular accidents). Patients with subarachnoid hemorrhage underwent a CT angiography procedure, whereas individuals in the control group underwent a magnetic resonance angiography procedure. Binary logistic regression was used to assess the association between cerebrovascular accidents and the anatomical variations of the circle of Willis. Conversely, Fisher’s exact test was used to compare the prevalence of aneurisms between subarachnoid hemorrhage patients with and without anatomical variations of the circle of Willis.Results: Among patients, there were 22 (22%) cases with anatomical variations of the circle of Willis compared with 10 (10%) individuals in the control group (P=0.033). There was no evidence of a statistically significant difference in the types of the anatomical variations of the circle of Willis between patients and controls (P=0.402). In age- and-sex adjusted logistic regression models, there was evidence of a significant positive association between cerebrovascular accidents and the anatomical variations of the circle of Willis (OR=1.87, 95%CI=1.03-4.68, P=0.048). Within the patients’ group, of the 52 cases with aneurisms, there were 22 (42.3%) individuals with anatomical variations of the circle of Willis compared with no individuals with anatomical variations among the 48 patients without aneurisms (P<0.001).Conclusion: This study provides useful evidence on the association between anatomical variations of the circle of Willis and cerebrovascular accidents in transitional Albania. Furthermore, findings from this study confirm the role of the anatomical variations of the circle of Willis in the occurrence of cerebral aneurisms

VARIAŢII ANATOMICE ALE POLIGONULUI WILLIS ÎN CREIERUL UMAN, LA ADULŢI. STUDIU CAZ-CONTROL ÎN ALBANIA

BACKGROUND: The aim of this study was to assess the association of anatomical variations of the circle of Willis with cerebrovascular disorders including hemorrhagic stroke and ischemic stroke. METHODS: A case-control study was conducted in Albania in 2012-2013 including a sample of 60 patients (30 patients with hemorrhagic stroke and 30 patients with ischemic stroke) and 60 controls (individuals without evidence of cerebrovascular accidents, but with signs of tension-type headache, or vertiginous syndrome). All patients with hemorrhagic stroke underwent a CT angiography procedure. Conversely, all patients with ischemic stroke and all controls underwent a magnetic resonance angiography examination.     RESULTS: In the overall sample of the patients there were 14 (23.3%) cases with anatomical variations of the circle of Willis compared with 10 (16.7%) individuals in the control group (P=0.49). Within the patients’ group, the prevalence of anatomical variations of the circle of Willis was somehow higher among cases with hemorrhagic stroke compared with cases with ischemic stroke (26.7% vs. 20.0%, respectively). There was no evidence of statistically significant difference in the types of the anatomical variations of the circle of Willis between patients and controls (P=0.71). In age- and-sex adjusted logistic regression models, there was evidence of a non-significant positive relationship between cerebrovascular accidents and the anatomical variations of the circle of Willis (OR=1.5, 95%CI=0.6-3.8, P=0.40). CONCLUSION: This is one of the very few reports from Albania shedding light into the association between anatomical variations of the circle of Willis and cerebrovascular accidents.      Keywords: Albania, cerebrovascular disorders, circle of Willis, hemorrhagic stroke, ischemic stroke.  CONTEXT: Scopul acestui studiu a fost evaluarea asociaţiei variațiilor anatomice ale poligonului Willis cu tulburările cerebrovasculare, inclusiv accidentele vasculare cerebrale hemoragice și ischemice.METODĂ: S-a efectuat un studiu caz-control, în Albania, în perioada 2012-2013, pe un eşantion de 60 de pacienţi (30 de pacienţi cu accident vascular cerebral hemoragic și 30 de pacienți cu accident vascular cerebral ischemic) şi 60 de martori în grupul control (subiecţi fără simptomatologie de accident vascular cerebral, dar cu semne de cefalee sau sindrom vertiginos). Tuturor pacienților cu accident vascular cerebral hemoragic li s-a efectuat o angiografie CT. In schimb, tuturor pacienţilor cu accident vascular cerebral ischemic și tuturor martorilor li s-a efectuat un examen angiografic prin rezonanță magnetică.REZULTATE: In întregul eşantion s-au găsit 14 (23,3%) cazuri cu variații anatomice ale poligonului Willis, comparativ cu 10 (16,7%) subiecţi din grupul control (p = 0,49). În cadrul grupului pacienților, prevalența variaţiilor anatomice ale poligonului Willis a fost oarecum mai mare în rândul cazurilor cu accident vascular cerebral hemoragic, comparativ cu subiecţii cu accident vascular cerebral ischemic (26,7% vs. 20,0%). Nu au existat diferențe semnificative statistic între tipurile de variațiile anatomice ale poligonului Willis între pacienți și martori (P = 0,71). Prin modelele de regresie logistică ajustate în funcţie de vârstă și sex s-a evidenţiat o relație pozitivă, nesemnificativă statistic între accidentele vasculare cerebrale și variațiile anatomice ale poligonului Willis (OR = 1,5, 95% CI = 0,6-3,8, P = 0,40) .CONCLUZII: Acesta este unul dintre puținele rapoartele din Albania despre asocierea dintre variațiile anatomice ale poligonului Willis și accidentele cerebrovasculare. Cuvinte cheie: Albania, tulburări cerebrovasculare, poligonul Willis, accident vascular cerebral hemoragic, accident vascular cerebral ischemic