Age and Sex-related Anatomical Variation in Vessel Diameters of Circle of Willis in Patients of Subarachnoid Haemorrhage using Digital Subtraction Angiography: A Retrospective Descriptive Study

Abstract

Introduction: Subarachnoid Haemorrhage (SAH) is a distinct form of stroke characterised by bleeding in the subarachnoid space. The incidence of SAH is influenced by various factors, including age, gender, and geographic location. Aim: To evaluate age and sex-related anatomical variation in vessel diameters of the Circle of Willis (CoW) in patients with SAH in Eastern India. Materials and Methods: A retrospective descriptive analysis was conducted on patients with ruptured intracranial aneurysms who were admitted to the Institute of Neurosciences in Kolkata and diagnosed with SAH using brain computed tomography between January 2014 and September 2015. Digital Subtraction Angiography (DSA) was performed on 50 patients, aged 15 to 70 years. The vessel diameters of CoW components were measured using specialised software. Statistical analysis using the Mann-Whitney test was conducted to assess differences in vessel diameters based on age and sex. Results: The results showed that older patients (≤40 years) had larger vessel diameters compared to younger patients (<40 years) in most segments of the CoW, indicating possible age-related atherosclerotic changes. Among female patients, the younger age group exhibited a significantly larger mean vessel diameter of 1.67 mm in the Anterior Cerebral Artery (ACA) (A1) segment of the left-side compared to the older age group with a mean vessel diameter of 1.32 mm in the same segment (p-value=0.045). In general, males had larger vessel diameters than females, except in specific segments. Conclusion: The knowledge gained from this research can contribute to improve the accuracy and effectiveness of interventions, such as endovascular coiling or surgical clipping, and ultimately optimising patient outcomes.

Keywords

• cerebral artery
• hypoplastic vessels
• morphometric variation
• neuroimaging