Influence of the collateral function of the circle of Willis on hemispherical perfusion during carotid occlusion as assessed by transcranial colour-coded duplex ultrasonography

Objectives: to investigate the collateral potential of the circle of Willis with transcranial colour-coded duplex ultrasonography and common carotid artery (CCA) compression.

Materials and methods: in 46 atherosclerotic patients without cerebrovascular disease, the functional patency of the collaterals of the circle of Willis, the anterior and posterior communicating arteries, was assessed. The Peak Systolic Velocity (PSV) decrease in the middle cerebral artery (MCA) during CCA compression between complete and incomplete circles was compared.

Results: in 10 (22%) patients a complete and in 36 (78%) patients an incomplete circle of Willis was found, mainly due to non-functioning posterior communicating arteries. In hemispheres with collateral supply through both the anterior and the posterior communicating artery, the median PSV decrease in the MCA during CCA compression was 43%. When the posterior, anterior or both communicating arteries (1 hemisphere) were missing the PSV decrease was 58% (p =0.003), 70% (p =0.001) and 75%, respectively.

Conclusions: collateral flow from the basilar to the carotid territory is often hampered by non-functioning posterior communicating arteries. A non-functioning anterior communicating artery is rare. A complete collateral circulation provides better perfusion of the MCA during carotid occlusion as compared with collateral supply through only the anterior or the posterior communicating artery in the case of an incomplete circle of Willis.