(Circulation. 1995;92:3122-3131.)
© 1995 American Heart Association, Inc.
Articles |
Effects of Anterior Communicating Artery Diameter on Cerebral Hemodynamics in Internal Carotid Artery Disease
A Model Study
From INSERM U.230, Service de Neurologie, CHU Purpan (F.C., V.V., P.B., M.Z., J.-P.M.-V.), Toulouse, France; the Laboratoire de Modélisation en Mécanique des Fluides, Université Paul-Sabatier (V.V., M.Z.), Toulouse, France; and Department of Functional Anatomy, University of Utrecht (B.H.), Netherlands.
Correspondence to J.-P. Marc-Vergnes, INSERM U.230, Service de Neurologie, CHU Purpan, 31059 Toulouse Cédex, France.
Background Collateral circulatory pathways are considered the primary determinant of cerebral hemodynamics in patients with obstructive lesions of the internal carotid arteries (ICaAs). However, the hemodynamic effects of the diameter of the anterior communicating artery (ACoA) have never been assessed quantitatively in humans.
Methods and Results Two different mathematical models were used to simulate changes affecting blood pressures and flows in cerebral arteries as a function of ACoA diameter and ICaA stenoses or occlusions. Small changes in ACoA diameter were found to have marked hemodynamic effects when they occurred within the range of 0.4 to 1.6 mm, a situation observed in 80% of the cases. Outside this range, changes in ACoA diameter had no effect. Simulated pressure drops through a stenotic ICaA were consistent with those observed. They were found to depend on the degrees of the stenoses in both ICaAs and on ACoA diameter according to a simple equation. Pressure reserve in the middle and anterior cerebral arteries decreased to below the lower limit of autoregulation, despite a normal mean arterial blood pressure, when the arteries were distal to a unique 70% ICaA stenosis associated with a small-diameter ACoA or to a 50% ICaA stenosis associated with a contralateral ICaA occlusion and a large-diameter ACoA. Above these thresholds, the circle of Willis allowed for an almost complete global cerebral blood flow compensation that involved all the afferent and communicating vessels.
Conclusions ACoA diameter strongly modulates the effects of ICaA lesions on cerebral hemodynamics. Some proposals for endarterectomy indications can be derived from our study.
Key Words: stenosis • blood pressure • carotid arteries • cerebrovascular disorders • computers
This article has been cited by other articles:
 |
|
 |
|
  P. Reymond, F. Merenda, F. Perren, D. Rufenacht, and N. Stergiopulos Validation of a one-dimensional model of the systemic arterial tree Am J Physiol Heart Circ Physiol, July 1, 2009; 297(1): H208 - H222. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Giannessi, M. Ursino, and W. B. Murray The Design of a Digital Cerebrovascular Simulation Model for Teaching and Research Anesth. Analg., December 1, 2008; 107(6): 1997 - 2008. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. Papantchev, S. Hristov, D. Todorova, E. Naydenov, A. Paloff, D. Nikolov, A. Tschirkov, and W. Ovtscharoff Some variations of the circle of Willis, important for cerebral protection in aortic surgery -- a study in Eastern Europeans Eur. J. Cardiothorac. Surg., June 1, 2007; 31(6): 982 - 989. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. J. van Laar, J. Hendrikse, C. J. M. Klijn, L. J. Kappelle, M. J. P. van Osch, and J. van der Grond Symptomatic Carotid Artery Occlusion: Flow Territories of Major Brain-Feeding Arteries Radiology, February 1, 2007; 242(2): 526 - 534. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Hendrikse, D. R. Rutgers, C. J.M. Klijn, B. C. Eikelboom, and J. van der Grond Effect of Carotid Endarterectomy on Primary Collateral Blood Flow in Patients With Severe Carotid Artery Lesions Stroke, July 1, 2003; 34(7): 1650 - 1654. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. W.J. Hoksbergen, C. B.L. Majoie, F.-J. H. Hulsmans, and D. A. Legemate Assessment of the Collateral Function of the Circle of Willis: Three-Dimensional Time-of-Flight MR Angiography Compared with Transcranial Color-Coded Duplex Sonography AJNR Am. J. Neuroradiol., March 1, 2003; 24(3): 456 - 462. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Hendrikse, M. J. Hartkamp, B. Hillen, W. P.T.M. Mali, and J. v. d. Grond Collateral Ability of the Circle of Willis in Patients With Unilateral Internal Carotid Artery Occlusion: Border Zone Infarcts and Clinical Symptoms Stroke, December 1, 2001; 32(12): 2768 - 2773. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Ursino, A. Ter Minassian, C. A. Lodi, and L. Beydon Cerebral hemodynamics during arterial and CO2 pressure changes: in vivo prediction by a mathematical model Am J Physiol Heart Circ Physiol, November 1, 2000; 279(5): H2439 - H2455. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. W. J. Hoksbergen, D. A. Legemate, D. T. Ubbink, and M. J. H. M. Jacobs Collateral Variations in Circle of Willis in Atherosclerotic Population Assessed by Means of Transcranial Color-Coded Duplex Ultrasonography Stroke, July 1, 2000; 31(7): 1656 - 1660. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. W. J. Hoksbergen, B. Fulesdi, D. A. Legemate, and L. Csiba Collateral Configuration of the Circle of Willis : Transcranial Color-Coded Duplex Ultrasonography and Comparison With Postmortem Anatomy Stroke, June 1, 2000; 31(6): 1346 - 1351. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Hartkamp, J. van der Grond, K. J. van Everdingen, B. Hillen, and W. P. T. M. Mali Circle of Willis Collateral Flow Investigated by Magnetic Resonance Angiography Stroke, December 1, 1999; 30(12): 2671 - 2678. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Kluytmans, J. van der Grond, K. J. van Everdingen, C. J. M. Klijn, L. J. Kappelle, and M. A. Viergever Cerebral Hemodynamics in Relation to Patterns of Collateral Flow Stroke, July 1, 1999; 30(7): 1432 - 1439. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Chollet, Y. Rolland, J.F. Albucher, C. Manelfe, J.P. Marc-Vergnes, and B. Guiraud-Chaumeil Recurrent Right Hemiplegia Associated With Progressive Ipsilateral Carotid Artery Stenosis Stroke, April 1, 1996; 27(4): 753 - 755. [Abstract] [Full Text]
|
|