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Laakkonen J, Nihtilä H, Jernvall J. Anatomical variations in the cerebral arterial circle of the Saimaa (Pusa hispida saimensis) and Baltic ringed seals (Pusa hispida botnica). Anat Rec (Hoboken) 2024; 307:677-689. [PMID: 37706632 DOI: 10.1002/ar.25322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/02/2023] [Accepted: 09/04/2023] [Indexed: 09/15/2023]
Abstract
The intracranial arterial vascularization of the Saimaa ringed seals (Pusa hispida saimensis; Nordquist, 1899) and Baltic ringed seals (Pusa hispida botnica; Gmelin, 1788) disclosed patterns of anatomical architecture comparable to that of other pinniped species. Arterial silicone casts on skull scaffolds, and magnetic resonance imaging (MRI) showed that the besides joining the caudal communicating arteries upon entering the cerebral arterial circle, the bilateral internal carotid arteries bifurcated as laterally oriented rostral choroidal arteries and rostral cerebral arteries. The latter arteries almost immediately gave off the laterally oriented middle cerebral arteries. Numerous individual variations were evident in differences in the exact branching sites of bilateral vessels or the size or number of arterial branches. Two Saimaa ringed seals had only a tiny foramen for the left internal carotid artery to enter the intracranial space, and the intracranial part of this vessel was short. It did not reach the cerebral arterial circle. The intracranial part of the right internal carotid artery is bifurcated and also supplied the left side of the cerebral arterial circle. Both specimens had aplasia of the left rostral cerebral artery. The intracranial arterial arrangement of Saimaa and Baltic ringed seals reflects the arterial architecture of this body region in terrestrial mammals with little evidence for aquatic adaptations or changes related to thermoregulation.
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Affiliation(s)
- Juha Laakkonen
- Division of Veterinary Anatomy and Developmental Biology, Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Heini Nihtilä
- Division of Veterinary Anatomy and Developmental Biology, Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Jukka Jernvall
- Institute of Biotechnology, University of Helsinki, Helsinki, Finland
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2
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Korte J, Klopp ES, Berg P. Multi-Dimensional Modeling of Cerebral Hemodynamics: A Systematic Review. Bioengineering (Basel) 2024; 11:72. [PMID: 38247949 PMCID: PMC10813503 DOI: 10.3390/bioengineering11010072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 12/23/2023] [Accepted: 01/06/2024] [Indexed: 01/23/2024] Open
Abstract
The Circle of Willis (CoW) describes the arterial system in the human brain enabling the neurovascular blood supply. Neurovascular diseases like intracranial aneurysms (IAs) can occur within the CoW and carry the risk of rupture, which can lead to subarachnoid hemorrhage. The assessment of hemodynamic information in these pathologies is crucial for their understanding regarding detection, diagnosis and treatment. Multi-dimensional in silico approaches exist to evaluate these hemodynamics based on patient-specific input data. The approaches comprise low-scale (zero-dimensional, one-dimensional) and high-scale (three-dimensional) models as well as multi-scale coupled models. The input data can be derived from medical imaging, numerical models, literature-based assumptions or from measurements within healthy subjects. Thus, the most realistic description of neurovascular hemodynamics is still controversial. Within this systematic review, first, the models of the three scales (0D, 1D, 3D) and second, the multi-scale models, which are coupled versions of the three scales, were discussed. Current best practices in describing neurovascular hemodynamics most realistically and their clinical applicablility were elucidated. The performance of 3D simulation entails high computational expenses, which could be reduced by analyzing solely the region of interest in detail. Medical imaging to establish patient-specific boundary conditions is usually rare, and thus, lower dimensional models provide a realistic mimicking of the surrounding hemodynamics. Multi-scale coupling, however, is computationally expensive as well, especially when taking all dimensions into account. In conclusion, the 0D-1D-3D multi-scale approach provides the most realistic outcome; nevertheless, it is least applicable. A 1D-3D multi-scale model can be considered regarding a beneficial trade-off between realistic results and applicable performance.
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Affiliation(s)
- Jana Korte
- Research Campus STIMULATE, University of Magdeburg, 39106 Magdeburg, Germany
- Department of Fluid Dynamics and Technical Flows, University of Magdeburg, 39106 Magdeburg, Germany
| | - Ehlar Sophie Klopp
- Research Campus STIMULATE, University of Magdeburg, 39106 Magdeburg, Germany
- Department of Medical Engineering, University of Magdeburg, 39106 Magdeburg, Germany
| | - Philipp Berg
- Research Campus STIMULATE, University of Magdeburg, 39106 Magdeburg, Germany
- Department of Medical Engineering, University of Magdeburg, 39106 Magdeburg, Germany
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3
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McCullough JWS, Coveney PV. High resolution simulation of basilar artery infarct and flow within the circle of Willis. Sci Rep 2023; 13:21665. [PMID: 38066041 PMCID: PMC10709551 DOI: 10.1038/s41598-023-48776-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
On a global scale, cerebro- and cardiovascular diseases have long been one of the leading causes of death and disability and their prevalence appears to be increasing in recent times. Understanding potential biomarkers and risk factors will help to identify individuals potentially at risk of suffering an ischemic stroke. However, the widely variable construction of the cerebral vasculature makes it difficult to provide a specific assessment without the knowledge of a patient's physiology. In this paper we use the 3D blood flow simulator HemeLB to study flow within three common structural variations of the circle of Willis during and in the moments after a blockage of the basilar artery. This tool, based on the lattice Boltzmann method, allows the 3D flow entering the basilar artery to be finely controlled to replicate the cessation of blood feeding this particular vessel-we demonstrate this with several examples including a sudden halt to flow and a gradual loss of flow over three heartbeat cycles. In this work we start with an individualised 3D representation of a full circle of Willis and then construct two further domains by removing the left or right posterior communicating arteries from this geometry. Our results indicate how, and how quickly, the circle of Willis is able to redistribute flow following such a stroke. Due to the choice of infarct, the greatest reduction in flow was observed in the posterior cerebral arteries where flow was reduced by up to 70% in some cases. The high resolution domains used in this study permit the velocity magnitude and wall shear stress to be analysed at key points during and following the stroke. The model we present here indicates how personalised vessels are required to provide the best insight into stroke risk for a given individual.
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Affiliation(s)
- Jon W S McCullough
- Centre for Computational Science, Department of Chemistry, University College London, London, UK
| | - Peter V Coveney
- Centre for Computational Science, Department of Chemistry, University College London, London, UK.
- Centre for Advanced Research Computing, University College London, London, UK.
- Informatics Institute, University of Amsterdam, Amsterdam, The Netherlands.
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Samavaki M, Oluwatoki Yusuf Y, Nia AZ, Söderholm S, Lahtinen J, Galaz Prieto F, Pursiainen S. Pressure-Poisson equation in numerical simulation of cerebral arterial circulation and its effect on the electrical conductivity of the brain. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 242:107844. [PMID: 37852144 DOI: 10.1016/j.cmpb.2023.107844] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 09/28/2023] [Accepted: 10/03/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND AND OBJECTIVE This study considers dynamic modeling of the cerebral arterial circulation and reconstructing an atlas for the electrical conductivity of the brain. Electrical conductivity is a governing parameter in several electrophysiological modalities applied in neuroscience, such as electroencephalography (EEG), transcranial electrical stimulation (tES), and electrical impedance tomography (EIT). While high-resolution 7-Tesla (T) Magnetic Resonance Imaging (MRI) data allow for reconstructing the cerebral arteries with a cross-sectional diameter larger than the voxel size, electrical conductivity cannot be directly inferred from MRI data. Brain models of electrophysiology typically associate each brain tissue compartment with a constant electrical conductivity, omitting any dynamic effects of cerebral blood circulation. Incorporating those effects poses the challenge of solving a system of incompressible Navier-Stokes equations (NSEs) in a realistic multi-compartment head model. However, using a simplified circulation model is well-motivated since, on the one hand, the complete system does not always have a numerically stable solution and, on the other hand, the full set of arteries cannot be perfectly reconstructed from the MRI data, meaning that any solution will be approximative. METHODS We postulate that circulation in the distinguishable arteries can be estimated via the pressure-Poisson equation (PPE), which is coupled with Fick's law of diffusion for microcirculation. To establish a fluid exchange model between arteries and microarteries, a boundary condition derived from the Hagen-Poisseuille model is applied. The relationship between the estimated volumetric blood concentration and the electrical conductivity of the brain tissue is approximated through Archie's law for fluid flow in porous media. RESULTS Through the formulation of the PPE and a set of boundary conditions (BCs) based on the Hagen-Poisseuille model, we obtained an equivalent formulation of the incompressible Stokes equation (SE). Thus, allowing effective blood pressure estimation in cerebral arteries segmented from open 7T MRI data. CONCLUSIONS As a result of this research, we developed and built a useful modeling framework that accounts for the effects of dynamic blood flow on a novel MRI-based electrical conductivity atlas. The electrical conductivity perturbation obtained in numerical experiments has an appropriate overall match with previous studies on this subject. Further research to validate these results will be necessary.
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Affiliation(s)
- Maryam Samavaki
- Mathematics, Computing Sciences, Tampere University, Korkeakoulunkatu 1, Tampere University, 33014, Finland.
| | - Yusuf Oluwatoki Yusuf
- Mathematics, Computing Sciences, Tampere University, Korkeakoulunkatu 1, Tampere University, 33014, Finland; Aix Marseille Univ, CNRS, Centrale Marseille, Institut Fresnel, Marseille, France
| | - Arash Zarrin Nia
- Faculty of Mathematics, K. N. Toosi University of Technology, Mirdamad Blvd, No. 470, Tehran, 1676-53381, Iran
| | - Santtu Söderholm
- Mathematics, Computing Sciences, Tampere University, Korkeakoulunkatu 1, Tampere University, 33014, Finland
| | - Joonas Lahtinen
- Mathematics, Computing Sciences, Tampere University, Korkeakoulunkatu 1, Tampere University, 33014, Finland
| | - Fernando Galaz Prieto
- Mathematics, Computing Sciences, Tampere University, Korkeakoulunkatu 1, Tampere University, 33014, Finland
| | - Sampsa Pursiainen
- Mathematics, Computing Sciences, Tampere University, Korkeakoulunkatu 1, Tampere University, 33014, Finland
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Magyar-Stang R, Pál H, Csányi B, Gaál A, Mihály Z, Czinege Z, Csipo T, Ungvari Z, Sótonyi P, Varga A, Horváth T, Bereczki D, Koller A, Debreczeni R. Assessment of cerebral autoregulatory function and inter-hemispheric blood flow in older adults with internal carotid artery stenosis using transcranial Doppler sonography-based measurement of transient hyperemic response after carotid artery compression. GeroScience 2023; 45:3333-3357. [PMID: 37599343 PMCID: PMC10643517 DOI: 10.1007/s11357-023-00896-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/16/2023] [Indexed: 08/22/2023] Open
Abstract
Unhealthy vascular aging promotes atherogenesis, which may lead to significant internal carotid artery stenosis (CAS) in 5 to 7.5% of older adults. The pathogenic factors that promote accelerated vascular aging and CAS also affect the downstream portion of the cerebral microcirculation in these patients. Primary treatments of significant CAS are eversion endarterectomy or endarterectomy with patch plasty. Factors that determine adequate hemodynamic compensation and thereby the clinical consequences of CAS as well as medical and surgical complications of carotid reconstruction surgery likely involve the anatomy of the circle of Willis (CoW), the magnitude of compensatory inter-hemispheric blood flow, and the effectiveness of cerebral microcirculatory blood flow autoregulation. This study aimed to test two hypotheses based on this theory. First, we hypothesized that patients with symptomatic and asymptomatic CAS would exhibit differences in autoregulatory function and inter-hemispheric blood flow. Second, we predicted that anatomically compromised CoW would associate with impaired inter-hemispheric blood flow compensation. We enrolled older adults with symptomatic or asymptomatic internal CAS (>70% NASCET criteria; n = 46) and assessed CoW integrity by CT angiography. We evaluated transient hyperemic responses in the middle cerebral arteries (MCA) after common carotid artery compression (CCC; 10 s) by transcranial Doppler sonography (TCD). We compared parameters reflecting autoregulatory function (e.g., transient hyperemic response ratio [THRR], return to baseline time [RTB], changes of vascular resistance) and inter-hemispheric blood flow (residual blood flow velocity). Our findings revealed that CAS was associated with impaired cerebral vascular reactivity. However, we did not observe significant differences in autoregulatory function or inter-hemispheric blood flow between patients with symptomatic and asymptomatic CAS. Moreover, anatomically compromised CoW did not significantly affect these parameters. Notably, we observed an inverse correlation between RTB and THRR, and 49% of CAS patients exhibited a delayed THRR, which associated with decreased inter-hemispheric blood flow. Future studies should investigate how TCD-based evaluation of autoregulatory function and inter-hemispheric blood flow can be used to optimize surgical techniques and patient selection for internal carotid artery revascularization.
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Affiliation(s)
- Rita Magyar-Stang
- Department of Neurology, Semmelweis University, Budapest, Hungary.
- János Szentágothai Doctoral School of Neurosciences, Semmelweis University, Budapest, Hungary.
| | - Hanga Pál
- Department of Neurology, Semmelweis University, Budapest, Hungary
- János Szentágothai Doctoral School of Neurosciences, Semmelweis University, Budapest, Hungary
| | - Borbála Csányi
- Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Anna Gaál
- Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Mihály
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Zsófia Czinege
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Tamas Csipo
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 731042, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Zoltan Ungvari
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 731042, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Peggy and Charles Stephenson Cancer Center, Oklahoma City, OK, 73104, USA
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Péter Sótonyi
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Andrea Varga
- Department of Diagnostic Radiology, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Tamás Horváth
- Research Center for Sport Physiology, Hungarian University of Sports Science, Budapest, Hungary
| | - Dániel Bereczki
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Akos Koller
- Research Center for Sport Physiology, Hungarian University of Sports Science, Budapest, Hungary
- Department of Morphology & Physiology, Faculty of Health Sciences, and Translational Medicine Institute, Faculty of Medicine, and ELKH-SE, Cerebrovascular and Neurocognitive Disorders Research Group, Semmelweis University, Budapest, Hungary
- Department of Physiology, New York Medical College, Valhalla, NY, USA
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6
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Sung D, Rejimon A, Allen JW, Fedorov AG, Fleischer CC. Predicting brain temperature in humans using bioheat models: Progress and outlook. J Cereb Blood Flow Metab 2023; 43:833-842. [PMID: 36883416 PMCID: PMC10196749 DOI: 10.1177/0271678x231162173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 03/09/2023]
Abstract
Brain temperature, regulated by the balance between blood circulation and metabolic heat generation, is an important parameter related to neural activity, cerebral hemodynamics, and neuroinflammation. A key challenge for integrating brain temperature into clinical practice is the lack of reliable and non-invasive brain thermometry. The recognized importance of brain temperature and thermoregulation in both health and disease, combined with limited availability of experimental methods, has motivated the development of computational thermal models using bioheat equations to predict brain temperature. In this mini-review, we describe progress and the current state-of-the-art in brain thermal modeling in humans and discuss potential avenues for clinical applications.
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Affiliation(s)
- Dongsuk Sung
- Department of Biomedical
Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA,
USA
- Department of Radiology and Imaging
Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Abinand Rejimon
- Department of Biomedical
Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA,
USA
- Department of Radiology and Imaging
Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Jason W Allen
- Department of Biomedical
Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA,
USA
- Department of Radiology and Imaging
Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Department of Neurology, Emory
University School of Medicine, Atlanta, GA, USA
| | - Andrei G Fedorov
- Woodruff School of Mechanical
Engineering, Georgia Institute of Technology, Atlanta, GA, USA
- Petit Institute for Bioengineering
and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA
| | - Candace C Fleischer
- Department of Biomedical
Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA,
USA
- Department of Radiology and Imaging
Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Petit Institute for Bioengineering
and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA
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7
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Díaz-Baamonde A, Peláez-Cruz R, Téllez MJ, Lantis J, Ulkatan S. Median nerve somatosensory evoked potential alarm related to head and neck positioning for carotid surgery. J Clin Monit Comput 2023; 37:699-704. [PMID: 35960492 DOI: 10.1007/s10877-022-00904-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/27/2022] [Indexed: 11/25/2022]
Abstract
Head positioning in carotid surgery represents an often overlooked but sensitive period in the surgical plan. A 53-year-old male presented a significant decrement in median nerve somatosensory evoked potential (mSEP) following head and neck positioning for carotid pseudoaneurysm repair before skin incision.Neurophysiological monitoring was performed with mSEP and electroencephalography early during the patient's preparation and surgery. Within five minutes after rotation and extension of the head to properly expose the surgical field, the contralateral m-SEP significantly decreased in both cortical (N20/P25) and subcortical (P14/N18) components. Partial neck correction led to m-SEP improvement, allowing to proceed with the carotid repair. We discuss possible underlying pathophysiological mechanisms responsible for these changes and highlight the relevance of an early start on monitoring to avoid neurological deficits.
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Affiliation(s)
- Alba Díaz-Baamonde
- Mount Sinai Roosevelt, Mount Sinai West Medical Center, New York, NY, USA.
| | | | - Maria J Téllez
- Mount Sinai Roosevelt, Mount Sinai West Medical Center, New York, NY, USA
| | - John Lantis
- Mount Sinai Roosevelt, Mount Sinai West Medical Center, New York, NY, USA
| | - Sedat Ulkatan
- Mount Sinai Roosevelt, Mount Sinai West Medical Center, New York, NY, USA
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8
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Quiroga A, Novi S, Martins G, Bortoletto LF, Avelar W, Guillaumon AT, Li LM, Cendes F, Mesquita RC. Quantification of the Tissue Oxygenation Delay Induced by Breath-Holding in Patients with Carotid Atherosclerosis. Metabolites 2022; 12:metabo12111156. [PMID: 36422296 PMCID: PMC9697605 DOI: 10.3390/metabo12111156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/16/2022] [Accepted: 11/19/2022] [Indexed: 11/24/2022] Open
Abstract
Carotid artery stenosis (CAS) is a common vascular disease with long-term consequences for the brain. Although CAS is strongly associated with impaired cerebral hemodynamics and neurodegeneration, the mechanisms underlying hemodynamic impairment in the microvasculature remain unknown. In this work, we employed functional near-infrared spectroscopy (fNIRS) to introduce a methodological approach for quantifying the temporal delay of the evoked hemodynamic response. The method was validated during a vasodilatory task (breath-holding) in 50 CAS patients and 20 controls. Our results suggest that the hemodynamic response to breath-holding can be delayed by up to 6 s in the most severe patients, a significant increase from the median 4 s measured for the control group (p = 0.01). In addition, the fraction of brain regions that responded to the task decreased as the CAS severity increased, from a median of 90% in controls to 73% in the most severe CAS group (p = 0.04). The presence of collateral circulation increases the response to breath-holding and decreases the average time delays across the brain, although the number of communicating arteries alone cannot predict these fNIRS-based hemodynamic variables (p > 0.09). Overall, this work proposes a method to quantitatively assess impaired cerebral hemodynamics in CAS patients.
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Affiliation(s)
- Andrés Quiroga
- “Gleb Wataghin” Institute of Physics, University of Campinas, Campinas 13083-859, SP, Brazil
- Correspondence: (A.Q.); (R.C.M.)
| | - Sergio Novi
- “Gleb Wataghin” Institute of Physics, University of Campinas, Campinas 13083-859, SP, Brazil
| | - Giovani Martins
- “Gleb Wataghin” Institute of Physics, University of Campinas, Campinas 13083-859, SP, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas 13083-970, SP, Brazil
| | - Luis Felipe Bortoletto
- “Gleb Wataghin” Institute of Physics, University of Campinas, Campinas 13083-859, SP, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas 13083-970, SP, Brazil
| | - Wagner Avelar
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas 13083-970, SP, Brazil
- Clinical Hospital, University of Campinas, Campinas 13083-888, SP, Brazil
- Faculty of Medical Sciences, University of Campinas, Campinas 13083-894, SP, Brazil
| | - Ana Terezinha Guillaumon
- Clinical Hospital, University of Campinas, Campinas 13083-888, SP, Brazil
- Faculty of Medical Sciences, University of Campinas, Campinas 13083-894, SP, Brazil
| | - Li Min Li
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas 13083-970, SP, Brazil
- Clinical Hospital, University of Campinas, Campinas 13083-888, SP, Brazil
- Faculty of Medical Sciences, University of Campinas, Campinas 13083-894, SP, Brazil
| | - Fernando Cendes
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas 13083-970, SP, Brazil
- Clinical Hospital, University of Campinas, Campinas 13083-888, SP, Brazil
- Faculty of Medical Sciences, University of Campinas, Campinas 13083-894, SP, Brazil
| | - Rickson Coelho Mesquita
- “Gleb Wataghin” Institute of Physics, University of Campinas, Campinas 13083-859, SP, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas 13083-970, SP, Brazil
- Correspondence: (A.Q.); (R.C.M.)
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9
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Determination of the Unilaterally Damaged Region May Depend on the Asymmetry of Carotid Blood Flow Velocity in Hemiparkinsonian Monkey: A Pilot Study. PARKINSON'S DISEASE 2022; 2022:4382145. [PMID: 36407681 PMCID: PMC9668443 DOI: 10.1155/2022/4382145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/13/2022] [Indexed: 11/11/2022]
Abstract
The hemiparkinsonian nonhuman primate model induced by unilateral injection of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) into the carotid artery is used to study Parkinson's disease. However, there have been no studies that the contralateral distribution of MPTP via the cerebral collateral circulation is provided by both the circle of Willis (CoW) and connections of the carotid artery. To investigate whether MPTP-induced unilaterally damaged regions were determined by asymmetrical cerebral blood flow, the differential asymmetric damage of striatal subregions, and examined structural asymmetries in a circle of Willis, and blood flow velocity of the common carotid artery were observed in three monkeys that were infused with MPTP through the left internal carotid artery. Lower flow velocity in the ipsilateral common carotid artery and a higher ratio of ipsilateral middle cerebral artery diameter to anterior cerebral artery diameter resulted in unilateral damage. Additionally, the unilateral damaged monkey observed the apomorphine-induced contralateral rotation behavior and the temporary increase of plasma RANTES. Contrastively, higher flow velocity in the ipsilateral common carotid artery was observed in the bilateral damaged monkey. It is suggested that asymmetry of blood flow velocity and structural asymmetry of the circle of Willis should be taken into consideration when establishing more efficient hemiparkinsonian nonhuman primate models.
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10
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Kızılgöz V, Kantarcı M, Kahraman Ş. Evaluation of Circle of Willis variants using magnetic resonance angiography. Sci Rep 2022; 12:17611. [PMID: 36266391 PMCID: PMC9585035 DOI: 10.1038/s41598-022-21833-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 10/04/2022] [Indexed: 01/13/2023] Open
Abstract
The Circle of Willis (COW) is an important collateral pathway to protect the persistence of cerebral blood perfusion. This study aims to investigate the morphological variants of this significant vascular structure with a large study population. 867 patients who had undergone MR angiography (MRA) evaluation were enrolled in this study. The MRA images of these patients obtained by the three-dimensional time-of-flight technique were re-interpreted to measure the vessel diameters of all components of the COW and classify the COW variations. In addition, correlations of the vessel calibers and the integrity of the COW with gender and age groups were presented. There was female dominance in the study population, and the mean age was 48. Type A was the most common variation in anterior (75.78%) and posterior (53.98%) circulation. Types G and H were the other common variation in the anterior circulation, and types E and D were the second and third common variations in the posterior COW, respectively. Smaller calibration for both ICAs, both P1s and BA were observed in females compared with the male group. Diameters of the BA, and both P1 segments were lower, and the left PCom diameter was significantly higher in the patients with a complete circle. There was a significant sex and age difference regarding the distribution of the complete, partially complete, and incomplete circle groups. The significant differences in the vessel calibers of specific components of the COW for complete, partial, and incomplete circulations revealed by this study should be explained with further research. In addition, meta-analyses with other studies in the literature might be a guide to understanding the morphological alterations of the COW and their relationships with a complete and non-complete circle.
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Affiliation(s)
- Volkan Kızılgöz
- grid.412176.70000 0001 1498 7262Department of Radiology, Faculty of Medicine, Erzincan Binali Yıldırım University, 24100 Erzincan, Turkey
| | - Mecit Kantarcı
- grid.412176.70000 0001 1498 7262Department of Radiology, Faculty of Medicine, Erzincan Binali Yıldırım University, 24100 Erzincan, Turkey ,grid.411445.10000 0001 0775 759XDepartment of Radiology,, Faculty of Medicine, Atatürk University, 25240 Erzurum, Turkey
| | - Şevket Kahraman
- grid.412176.70000 0001 1498 7262Department of Radiology, Faculty of Medicine, Erzincan Binali Yıldırım University, 24100 Erzincan, Turkey
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11
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Investigation of Flow Changes in Intracranial Vascular Disease Models Constructed with MRA Images. SENSORS 2022; 22:s22062302. [PMID: 35336474 PMCID: PMC8949996 DOI: 10.3390/s22062302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 02/04/2023]
Abstract
This study aimed to develop a magnetic resonance imaging (MRI)-compatible flow delivery system and individualized models of circle of Willis (CoW), which include 50% and 100% blockage in internal carotid artery (ICA50 and ICA100), and 100% blockage in vertebral artery (VA100). Images were obtained using 3D time-of-flight and phase-contrast magnetic resonance angiography (MRA) sequences, and changes in velocity and flow direction at CoW models were analyzed. For the ICA50 and VA100 models, the flow was similar to that of the normal model. For the ICA 50 model, it was found that 50% blockage did not affect cerebral blood flow. For the VA100 model, decreased flow in the posterior cerebral artery and a change to the flow direction in the posterior communicating artery were found. For the ICA100 model, particularly, decreased flow in the ipsilateral middle and anterior cerebral arteries and a change to the flow direction in the ipsilateral anterior cerebral artery of the CoW were found. These results demonstrated that the flow system with various CoW disease models tailored to individual characteristics could be used to predict stroke onset more quickly. For the ICA50 and VA100 models, the possibility of cerebral infarction was significantly lower. On the other hand, for the ICA100 model, there was a high possibility of decreased flow, which could lead to cerebral infarction.
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12
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Dmytriw AA, Bickford S, Pezeshkpour P, Ha W, Amirabadi A, Dibas M, Kitamura LA, Vidarsson L, Pulcine E, Muthusami P. Rotational Vertebrobasilar Insufficiency: Is There a Physiological Spectrum? Phase-Contrast Magnetic Resonance Imaging Quantification in Healthy Volunteers. Pediatr Neurol 2022; 128:58-64. [PMID: 35101804 DOI: 10.1016/j.pediatrneurol.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/07/2021] [Accepted: 12/11/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Some cases of cerebral ischemia have been attributed to dynamic flow limitation in neck vessels. It however remains unknown whether this represents the extreme end of a physiological response. METHODS Eighteen healthy volunteers were recruited to this prospective study. Cervical blood flow (ml/min/m2) was assessed using phase-contrast MRI, and cerebral perfusion ratios were assessed using arterial spin labeling perfusion at neutral position, predefined head rotations, as well as flexion and extension. Inter-reader agreements were assessed using intraclass correlation coefficient. RESULTS The mean age was 38.6 ± 10.8 (range = 22-56) years, for five male participants and 13 females. The means for height and weight were 168 cm and 73.2 kg, respectively. There were no significant differences in individual arterial blood flow with change in head position (P > 0.05). Similarly, the repeated-measures analysis of variance test demonstrated no significant difference in perfusion ratios in relation to head position movement (P > 0.05). Inter-reader agreement was excellent (intraclass correlation coefficient = 0.97). CONCLUSIONS There is neither significant change in either individual cervical arterial blood flow nor cerebral perfusion within the normal physiological/anatomical range of motion in healthy individuals. It is therefore reasonable to conclude that any such hemodynamic change identified in a patient with ischemic stroke be considered causative.
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Affiliation(s)
- Adam A Dmytriw
- Divisions of Neuroradiology and Image Guided Therapy, Department of Diagnostic Imaging, University of Toronto, Toronto, Ontario, Canada.
| | - Suzanne Bickford
- Divisions of Neuroradiology and Image Guided Therapy, Department of Diagnostic Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Parneyan Pezeshkpour
- Divisions of Neuroradiology and Image Guided Therapy, Department of Diagnostic Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Winston Ha
- Divisions of Neuroradiology and Image Guided Therapy, Department of Diagnostic Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Afsaneh Amirabadi
- Divisions of Neuroradiology and Image Guided Therapy, Department of Diagnostic Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Mahmoud Dibas
- Divisions of Neuroradiology and Image Guided Therapy, Department of Diagnostic Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Lee Ann Kitamura
- Divisions of Neuroradiology and Image Guided Therapy, Department of Diagnostic Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Logi Vidarsson
- Divisions of Neuroradiology and Image Guided Therapy, Department of Diagnostic Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Pulcine
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Prakash Muthusami
- Divisions of Neuroradiology and Image Guided Therapy, Department of Diagnostic Imaging, University of Toronto, Toronto, Ontario, Canada
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13
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Haemodynamic Analysis of Branched Endografts for Complex Aortic Arch Repair. Bioengineering (Basel) 2022; 9:bioengineering9020045. [PMID: 35200399 PMCID: PMC8868591 DOI: 10.3390/bioengineering9020045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 11/17/2022] Open
Abstract
This study aims to investigate the haemodynamic response induced by implantation of a double-branched endograft used in thoracic endovascular aortic repair (TEVAR) of the aortic arch. Anatomically realistic models were reconstructed from CT images obtained from patients who underwent TEVAR using the RelayPlus double-branched endograft implanted in the aortic arch. Two cases (Patient 1, Patient 2) were included here, both patients presented with type A aortic dissection before TEVAR. To examine the influence of inner tunnel branch diameters on localised flow patterns, three tunnel branch diameters were tested using the geometric model reconstructed for Patient 1. Pulsatile blood flow through the models was simulated by numerically solving the Navier–Stokes equations along with a transitional flow model. The physiological boundary conditions were imposed at the model inlet and outlets, while the wall was assumed to be rigid. Our simulation results showed that the double-branched endograft allowed for the sufficient perfusion of blood to the supra-aortic branches and restored flow patterns expected in normal aortas. The diameter of tunnel branches in the device plays a crucial role in the development of flow downstream of the branches and thus must be selected carefully based on the overall geometry of the vessel. Given the importance of wall shear stress in vascular remodelling and thrombus formation, longitudinal studies should be performed in the future in order to elucidate the role of tunnel branch diameters in long-term patency of the supra-aortic branches following TEVAR with the double-branched endograft.
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14
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Westphal LP, Lohaus N, Winklhofer S, Manzolini C, Held U, Steigmiller K, Hamann JM, El Amki M, Dobrocky T, Panos LD, Kaesmacher J, Fischer U, Heldner MR, Luft AR, Gralla J, Arnold M, Wiest R, Wegener S. Circle of Willis variants and their association with outcome in patients with middle cerebral artery-M1-occlusion stroke. Eur J Neurol 2021; 28:3682-3691. [PMID: 34233384 PMCID: PMC8596978 DOI: 10.1111/ene.15013] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/04/2021] [Indexed: 11/30/2022]
Abstract
Background An incomplete circle of Willis (CoW) has been associated with a higher risk of stroke and might affect collateral flow in large vessel occlusion (LVO) stroke. We aimed to investigate the distribution of CoW variants in a LVO stroke and transient ischemic attack (TIA) cohort and analyze their impact on 3‐month functional outcome. Methods CoW anatomy was assessed with time‐of‐flight magnetic resonance angiography (TOF‐MRA) in 193 stroke patients with acute middle cerebral artery (MCA)‐M1‐occlusion receiving endovascular treatment (EVT) and 73 TIA patients without LVO. The main CoW variants were categorized into four vascular models of presumed collateral flow via the CoW. Results 82.4% (n = 159) of stroke and 72.6% (n = 53) of TIA patients had an incomplete CoW. Most variants affected the posterior circulation (stroke: 77.2%, n = 149; TIA: 58.9%, n = 43; p = 0.004). Initial stroke severity defined by the National Institutes of Health Stroke Scale (NIHSS) on admission was similar for patients with and without CoW variants. CoW integrity did not differ between groups with favorable (modified Rankin Scale [mRS]): 0–2) and unfavorable (mRS: 3–6) 3‐month outcome. However, we found trends towards a higher mortality in patients with any type of CoW variant (p = 0.08) and a higher frequency of incomplete CoW among patients dying within 3 months after stroke onset (p = 0.119). In a logistic regression analysis adjusted for the potential confounders age, sex and atrial fibrillation, neither the vascular models nor anterior or posterior variants were independently associated with outcome. Conclusion Our data provide no evidence for an association of CoW variants with clinical outcome in LVO stroke patients receiving EVT.
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Affiliation(s)
- Laura P Westphal
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Niklas Lohaus
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Sebastian Winklhofer
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Christian Manzolini
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Ulrike Held
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Klaus Steigmiller
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Janne M Hamann
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Mohamad El Amki
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Tomas Dobrocky
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Berne and University of Berne, Berne, Switzerland
| | - Leonidas D Panos
- Department of Neurology, University Hospital Berne and University of Berne, Berne, Switzerland
| | - Johannes Kaesmacher
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Berne and University of Berne, Berne, Switzerland.,Department of Diagnostic, Interventional and Pediatric Radiology, University Hospital Berne and University of Berne, Berne, Switzerland
| | - Urs Fischer
- Department of Neurology, University Hospital Berne and University of Berne, Berne, Switzerland
| | - Mirjam R Heldner
- Department of Neurology, University Hospital Berne and University of Berne, Berne, Switzerland
| | - Andreas R Luft
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Jan Gralla
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Berne and University of Berne, Berne, Switzerland
| | - Marcel Arnold
- Department of Neurology, University Hospital Berne and University of Berne, Berne, Switzerland
| | - Roland Wiest
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Berne and University of Berne, Berne, Switzerland
| | - Susanne Wegener
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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15
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Abdi M, NavidBakhsh M. Collateral flow at circle of Willis in healthy condition. Perfusion 2021; 37:293-305. [PMID: 33594933 DOI: 10.1177/0267659120987550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Experimental simulation of cerebrovascular system would be very beneficial tool to evaluate millions of human body cascade sequence. The Circle of Willis (CoW) recently named Cerebral Arterial Circle (CAC) is a main loop structure of cerebral circulatory system which positioned at the cranium base. In this research, we investigate cerebral artery flow pattern in cerebral arteries including afferent, Willisian, and efferent arteries of CAC emphasizing on communicating and connecting arteries which are main routes in CAC and as a risky sites when autoregulation is occurred in terminal parts of middle cerebral arteries (MCAs) by PMMA (Polymethyl methacrylate) chip and high quality camera which depict Sequential images. This novelty study analyze flow pattern in CAC that have been challenging subject area for many years which have investigated by scientists yet, because flow pattern in CAC indicate complication progression. This research tries to construct new platform in cerebral circulation analyzing method by reliable experimental in-vitro approach. The outcomes of this study demonstrate that communicating arteries especially anterior communicating artery (ACoA) is main artery in CAC flow distribution.
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Affiliation(s)
- Mohsen Abdi
- School of Mechanical Engineering, Iran University of Science and Technology, Tehran, Iran.,Tissue Engineering and Biological Systems Research Laboratory, School of Mechanical Engineering, Iran University of Science and Technology, Tehran, Iran
| | - Mahdi NavidBakhsh
- School of Mechanical Engineering, Iran University of Science and Technology, Tehran, Iran.,Tissue Engineering and Biological Systems Research Laboratory, School of Mechanical Engineering, Iran University of Science and Technology, Tehran, Iran
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16
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Coulier B. Morphologic variants of the Cerebral Arterial Circle on computed tomographic angiography (CTA): a large retrospective study. Surg Radiol Anat 2021; 43:417-426. [PMID: 33483832 DOI: 10.1007/s00276-020-02661-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/15/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To confirm and illustrate the great variability of morphology of the Cerebral Arterial Circle (CAC)-also commonly called "Circle of Willis"-in current clinical Computed Tomography Angiography (CTA) practice. METHODS Computed Tomographic Angiographic 3D Volume Rendering reconstructions of the CAC performed in a series of 511 patients were retrospectively reviewed and classified following their anatomic configuration. RESULTS An amount of 27 CAC configurations were listed. Complete and "nearly complete" (1 missing segment) CACs were found in 115 (22.58%) and 157 (28.6%) patients. The posterior arch was much more frequently incomplete (374 patients = 73.18%) than the anterior arch (96 patients = 18.4%). The main cause was a high prevalence of missing posterior communicating arteries (PCoAs). The left or right PCoA were unilaterally lacking in 156 patients (30.53%) and both PCoAs were lacking in 179 patients (35.02%). Cases with 2 and 3 missing segments were observed in 184 (36%) and 44 patients (8.6%). Precarious situations were also identified including 7 cases (1.4%) of complete isolation of the middle cerebral artery (MCA), 11 cases (2.15%) of absence of interhemispheric supply, 205 cases (40.1%) of full separation of the carotid and vertebra-basilar (VB) territories and 44 cases (8.6%) of full separation of the three main arterial axes (both ICAs and VB). The prevalence of Fetal Posterior Cerebral Arteries (FPCA) variants was also reported. A "Full" FPCA was found unilaterally in 48 (9.4%) and bilaterally in 13 (2.54%) of patients. Apart from agenesis and hypoplasia reported in our study, various other variations of the anterior complex of the CAC (ACoA and A2 segments of the ACA) were also noted. CONCLUSION CTA with 3D Volume Rendering may powerfully assess the numerous variations of the CAC. This assessment is of prime importance for the evaluation of patients presenting with risk factors or in whom neurosurgery, cardiac surgery, interventional radiology or carotid endarterectomy (CEA) are being considered.
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Affiliation(s)
- Bruno Coulier
- Departments of Diagnostic Radiology, Clinique St Luc, 5004, Bouge, Namur, Belgium.
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17
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Lukyanchikov VA, Orlov EA, Oganesyan MV, Gordeeva AA, Pavliv MP. [Anatomical bases of brain revascularization: choosing an extra-intracranial bypass option]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2021; 85:120-126. [PMID: 34951769 DOI: 10.17116/neiro202185061120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Surgical brain revascularization is an important treatment for acute or chronic ischemia, intracranial aneurysms and skull base tumors. Individual anatomy of brain vessels should be clearly understood for this procedure. Variants of collateral cerebral blood flow in patients with cerebrovascular diseases depend on individual characteristics of circle of Willis and reserve mechanisms of collateral circulation. These anatomical variations require careful preoperative planning to choose the optimal revascularization option.
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Affiliation(s)
- V A Lukyanchikov
- University's Hospital of the Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
- Russian People's Friendship University, Moscow, Russia
| | - E A Orlov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - M V Oganesyan
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A A Gordeeva
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - M P Pavliv
- Sechenov First Moscow State Medical University, Moscow, Russia
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18
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Fenrich M, Habjanovic K, Kajan J, Heffer M. The circle of Willis revisited: Forebrain dehydration sensing facilitated by the anterior communicating artery: How hemodynamic properties facilitate more efficient dehydration sensing in amniotes. Bioessays 2020; 43:e2000115. [PMID: 33191609 DOI: 10.1002/bies.202000115] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 10/10/2020] [Accepted: 10/13/2020] [Indexed: 12/14/2022]
Abstract
We hypothesize that threat of dehydration provided selection pressure for the evolutionary emergence and persistence of the anterior communicating artery (ACoA - the inter-arterial connection that completes the Circle of Willis) in early amniotes. The ACoA is a hemodynamically insignificant artery, but, as we argue in this paper, its privileged position outside the blood-brain barrier gives it a crucial sensing function for the osmolarity of the blood against the background of the rest of the brain, which efficiently protects itself from dehydration. Till now, the questions of why the ACoA evolved, and what its physiological function is, have remained unsatisfactorily answered. The traditional view-that the ACoA serves as a collateral source of vascularization in case of arterial stenosis-is anthropocentric, and not in accordance with principles of natural selection that apply more generally. Diseases underlying arterial stenosis are associated with aging and the human lifestyle, so this cannot explain why the ACoA formed hundreds of millions of years ago and persisted in amniotes to this day. The peculiar hemodynamic properties of the ACoA could be selected traits that allowed for more efficient forebrain detection of dehydration and complex behavioral responses to water loss, a major advantage in the survival of early amniotes. This hypothesis also explains insufficient hydration often seen in elderly humans.
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Affiliation(s)
- Matija Fenrich
- Laboratory of Neurobiology, Faculty of Medicine, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Karlo Habjanovic
- Laboratory of Neurobiology, Faculty of Medicine, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Josip Kajan
- Laboratory of Neurobiology, Faculty of Medicine, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Marija Heffer
- Laboratory of Neurobiology, Faculty of Medicine, J. J. Strossmayer University of Osijek, Osijek, Croatia
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19
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Zhang J, Can A, Mukundan S, Steigner M, Castro VM, Dligach D, Finan S, Yu S, Gainer V, Shadick NA, Savova G, Murphy S, Cai T, Wang Z, Weiss ST, Du R. Morphological Variables Associated With Ruptured Middle Cerebral Artery Aneurysms. Neurosurgery 2020; 85:75-83. [PMID: 29850834 DOI: 10.1093/neuros/nyy213] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/27/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Geometric factors of intracranial aneurysms and surrounding vasculature could affect the risk of aneurysm rupture. However, large-scale assessments of morphological parameters correlated with intracranial aneurysm rupture in a location-specific manner are scarce. OBJECTIVE To investigate the morphological characteristics associated with ruptured middle cerebral artery (MCA) aneurysms. METHODS Five hundred sixty-one patients with 638 MCA aneurysms diagnosed between 1990 and 2016 who had available computed tomography angiography (CTA) were included in this study. CTAs were evaluated using the Vitrea Advanced Visualization software for 3-dimensional (3D) reconstruction. Morphological parameters examined in each model included aneurysm projection, wall irregularity, presence of a daughter dome, presence of hypoplastic or aplastic A1 arteries and hypoplastic or fetal posterior communicating arteries (PCoA), aneurysm height and width, neck diameter, bottleneck factor, aspect and size ratio, height/width ratio, and diameters and angles of surrounding parent and daughter vessels. Univariable and multivariable statistical analyses were performed to determine the association of morphological characteristics with rupture of MCA aneurysms. Logistic regression was used to build a predictive MCA score. RESULTS Greater bottleneck and size ratio, and irregular, multilobed, temporally projecting MCA aneurysms are associated with higher rupture risk, whereas higher M1/M2 ratio, larger width, and the presence of an ipsilateral or bilateral hypoplastic PCoA were inversely associated with rupture. The MCA score had good predictive capacity with area under the receiver operating curve = 0.88. CONCLUSION These practical morphological parameters specific to MCA aneurysms are easy to assess when examining 3D reconstructions of unruptured aneurysms and could aid in risk evaluation in these patients.
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Affiliation(s)
- Jian Zhang
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Jiangsu Province, China
| | - Anil Can
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Srinivasan Mukundan
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael Steigner
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Victor M Castro
- Research Information Systems and Computing, Partners Healthcare, Boston, Massachusetts
| | - Dmitriy Dligach
- Department of Computer Science, Loyola University, Chicago, Illinois
| | - Sean Finan
- Boston Children's Hospital Informatics Program, Boston, Massachusetts
| | - Sheng Yu
- Center for Statistical Science, Tsinghua University, Beijing, China
| | - Vivian Gainer
- Research Information Systems and Computing, Partners Healthcare, Boston, Massachusetts
| | - Nancy A Shadick
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts
| | - Guergana Savova
- Boston Children's Hospital Informatics Program, Boston, Massachusetts
| | - Shawn Murphy
- Research Information Systems and Computing, Partners Healthcare, Boston, Massachusetts.,Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Tianxi Cai
- Biostatistics, Harvard School of Public Health, Boston, Massachusetts
| | - Zhong Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Jiangsu Province, China
| | - Scott T Weiss
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Rose Du
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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20
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Zhu G, Wei Y, Yuan Q, Yang J, Yeo JH. PIV investigation of the flow fields in subject-specific vertebro-basilar (VA-BA) junction. Biomed Eng Online 2019; 18:93. [PMID: 31492145 PMCID: PMC6731569 DOI: 10.1186/s12938-019-0711-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 08/20/2019] [Indexed: 12/25/2022] Open
Abstract
Background As the only arterial structure of which two main arteries merged into one, the vertebro-basilar (VA-BA) system is one of the favorite sites of cerebral atherosclerotic plaques. The aim of this study was to investigate the detailed hemodynamics characteristics in the VA-BA system. Methods A scale-up subject-specific flow phantom of VA-BA system was fabricated based on the computed tomography angiography (CTA) scanning images of a healthy adult. Flow fields in eight axial planes and six radial planes were measured and analyzed by using particle image velocimetry (PIV) under steady flow conditions of \documentclass[12pt]{minimal}
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\begin{document}$${Re}=300$$\end{document}Re=300, \documentclass[12pt]{minimal}
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\begin{document}$${Re}=500$$\end{document}Re=500. A water–glycerin mixture was used as the working fluid. Results The flow in the current model exhibited highly three-dimensional characteristics. The confluence of VAs flow formed bimodal velocity distribution near the confluence apex. Due to the asymmetrical structural configuration, the bimodal velocity profile skewed towards left, and sharper peaks were observed under higher Reynolds condition. Secondary flow characterized by two vortices formed in the radial planes where 10 mm downstream the confluence apex and persists along the BA under both Reynolds numbers. The strength of secondary flow under \documentclass[12pt]{minimal}
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\begin{document}$${Re}=500$$\end{document}Re=500 is around 8% higher than that under \documentclass[12pt]{minimal}
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\begin{document}$${Re}=300$$\end{document}Re=300, and decayed nonlinearly along the flow direction. In addition, a low momentum recirculation region induced by boundary layer separation was observed near the confluence apex. The wall shear stress (WSS) in the recirculation area was found to be lower than 0.4 Pa. This region coincides well with the preferential site of vascular lesions in the VA-BA system. Conclusions This preliminary study verified that the subject-specific in-vitro experiment is capable of reflecting the detailed flow features in the VA-BA system. The findings from this study may help to expand the understanding of the hemodynamics in the VA-BA system, and further clarifying the mechanism that underlying the localization of vascular lesions.
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Affiliation(s)
- Guangyu Zhu
- School of Energy and Power Engineering, Xi'an Jiaotong University, No. 28 Xian Ning West Road, Xi'an, 710049, China
| | - Yuan Wei
- School of Energy and Power Engineering, Xi'an Jiaotong University, No. 28 Xian Ning West Road, Xi'an, 710049, China
| | - Qi Yuan
- School of Energy and Power Engineering, Xi'an Jiaotong University, No. 28 Xian Ning West Road, Xi'an, 710049, China.
| | - Jian Yang
- Department of Radiology and Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta Weest Road, Xi'an, 710061, China
| | - Joon Hock Yeo
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
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21
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Zhou C, Yuan C, Li R, Wang W, Li C, Zhao X. Association Between Incomplete Circle of Willis and Carotid Vulnerable Atherosclerotic Plaques. Arterioscler Thromb Vasc Biol 2018; 38:2744-2749. [PMID: 30354232 DOI: 10.1161/atvbaha.118.311797] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective—
Carotid high-risk plaque, characterized by intraplaque hemorrhage, fibrous cap rupture, and large lipid-rich necrotic core, is associated with cerebrovascular events. This study sought to investigate the relationship between high-risk carotid plaque and an incomplete circle of Willis (COW).
Approach and Results—
Patients were recruited from a multicenter study, Chinese Atherosclerosis Risk Evaluation (CARE-II) and underwent 3-dimensional time-of-flight magnetic resonance angiography for intracranial arteries and 2-dimensional multicontrast magnetic resonance vessel wall imaging for carotid arteries on a 3.0T magnetic resonance scanner. The integrity of the COW in anterior and posterior portions was evaluated. Characteristics of carotid plaques were assessed. Correlation between incomplete COW and carotid plaque features was determined. Of 482 eligible patients, patients with carotid intraplaque hemorrhage showed significantly higher prevalence of an incomplete anterior COW (52.7% versus 38.5%;
P
=0.022) compared with those without. An incomplete anterior COW was associated with intraplaque hemorrhage before (odds ratio, 1.781; 95% CI, 1.083–2.931;
P
=0.023) and after adjusted for clinical risk factors (odds ratio, 1.945; 95% CI, 1.139–3.321;
P
=0.015). The unilateral carotid artery stenosis showed no correlation with incomplete anterior COW and posterior COW (all
P
>0.025). No significant associations were found between other plaque features and any type of incomplete COW (all
P
>0.025).
Conclusions—
An incomplete COW is independently associated with intraplaque hemorrhage of carotid atherosclerotic plaques.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT02017756.
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Affiliation(s)
- Changwu Zhou
- From the Department of Radiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, China (C.Z., W.W.)
| | - Chun Yuan
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China (C.Y., R.L., X.Z.)
- Department of Radiology, University of Washington, Seattle (C.Y.)
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China (C.Y., R.L., X.Z.)
| | - Wei Wang
- From the Department of Radiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, China (C.Z., W.W.)
| | - Cheng Li
- Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China (C.L.)
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China (C.Y., R.L., X.Z.)
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22
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Liebeskind DS. Mapping the collaterome for precision cerebrovascular health: Theranostics in the continuum of stroke and dementia. J Cereb Blood Flow Metab 2018; 38:1449-1460. [PMID: 28555527 PMCID: PMC6125977 DOI: 10.1177/0271678x17711625] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 04/04/2017] [Accepted: 04/29/2017] [Indexed: 01/10/2023]
Abstract
Precision cerebrovascular health or individualized long-term preservation of the brain and associated blood vessels, is predicated on understanding, diagnosing, and tailoring therapies for people at risk of ischemic injury associated with stroke and vascular dementia. The associated imaging patterns are sculpted by the protective effect of the collaterome, the innate compensatory ability of the brain and vasculature to offset hypoperfusion when antegrade or normal arterial inflow pathways are compromised. Theranostics or rational and synchronous use of diagnostic studies in tandem with specific therapies to optimally guide patient outcomes in ischemic brain disorders may capitalize on the pivotal role of the collaterome. Understanding the functional impact of the collaterome across populations of individuals would advance translational science on the brain, while questions with immediate clinical implications may be prioritized. Big data and systematic analyses are necessary to develop normative standards, multimodal imaging atlases, and delineation of specific patterns to guide clinical management. Large-scale, systematic imaging analyses of the collaterome provide a platform for translational work on cerebral collateral circulation and hemodynamics and a theranostic framework with direct clinical implications. This article frames incipient research objectives to guide precision stroke medicine in coming years, building upon the collaterome concept in brain health.
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Affiliation(s)
- David S Liebeskind
- Neurovascular Imaging Research Core and UCLA Stroke Center, Los Angeles, CA, USA
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23
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Forgó B, Tárnoki ÁD, Tárnoki DL, Littvay L, Fagnani C, Stazi MA, Meneghetti G, Medda E, Farina F, Baracchini C. Investigation of circle of Willis variants and hemodynamic parameters in twins using transcranial color-coded Doppler sonography. Int J Cardiovasc Imaging 2018; 34:1419-1427. [PMID: 29675634 DOI: 10.1007/s10554-018-1359-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 04/16/2018] [Indexed: 11/30/2022]
Abstract
Morphological and hemodynamic variations of the circle of Willis (CW) may have an important impact on cerebrovascular events. However, the environmental and genetic influence remains unclear. For this reason we studied the variations and hemodynamic parameters of the CW in twins using transcranial color-coded sonography (TCCS). Sixty-four twins, 19 monozygotic (MZ) and 13 dizygotic (DZ) pairs from the Italian Twin Registry (average age 45.0 ± 13.7 years) underwent TCCS and risk factor assessment. We examined CW morphology and recorded peak systolic velocity (PSV), end-diastolic velocity (EDV) and pulsatility index (PI). Raw heritability was determined for hemodynamic parameters, whereas concordance and discordance rates were calculated for CW morphological variants. A normal CW anatomy was observed in the majority of MZ and DZ twins (76.5% and 92.3%, respectively). The most frequent variant was a missing anterior cerebral artery (ACA). There was no significant difference in the prevalence of most CW variants depending on the zigosity. Concordance rates were low regarding the presence of variant CW anatomy both in MZ and DZ groups (0.14 and 0.00, respectively). Women had a significantly higher PI in vertebral arteries (VA) and in the right ACA (p = 0.01, p = 0.02 and p < 0.01, respectively). An inverse correlation was observed between hemodynamic parameters and age. Morphological variants of the CW do not seem to be heritable; they are most likely determined by environmental factors. In contrast, hemodynamic parameters of the CW are moderately heritable and this might have implications in the management and prevention of cerebrovascular diseases.
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Affiliation(s)
- Bianka Forgó
- Department of Radiology, Semmelweis University, Üllői Street 78/A, Budapest, 1082, Hungary.
| | - Ádám Domonkos Tárnoki
- Department of Radiology, Semmelweis University, Üllői Street 78/A, Budapest, 1082, Hungary.,Hungarian Twin Registry, Erdélyi Street 29, Budapest, 1212, Hungary
| | - Dávid László Tárnoki
- Department of Radiology, Semmelweis University, Üllői Street 78/A, Budapest, 1082, Hungary.,Hungarian Twin Registry, Erdélyi Street 29, Budapest, 1212, Hungary
| | - Levente Littvay
- Central European University, Nádor Street 9, Budapest, 1051, Hungary
| | - Corrado Fagnani
- Centre for Behavioural Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Maria Antonietta Stazi
- Centre for Behavioural Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Giorgio Meneghetti
- Department of Neurosciences, University of Padua School of Medicine, via Giustiniani 5, 35128, Padua, Italy
| | - Emanuela Medda
- Centre for Behavioural Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Filippo Farina
- Department of Neurosciences, University of Padua School of Medicine, via Giustiniani 5, 35128, Padua, Italy
| | - Claudio Baracchini
- Department of Neurosciences, University of Padua School of Medicine, via Giustiniani 5, 35128, Padua, Italy
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