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An Autopsic Study on Bilateral Hypoplasia of the Posterior Communicating Arteries in Cerebrovascular Diseases

Ana-Maria Dumitrescu, Anca Sava, Dana Mihaela Turliuc, Andrei Ionut Cucu, Roxana Sufaru, Ioan Gotca, Irena Cristina Grierosu and Serban Turliuc

Objective: To identify the clinical consequences of bilateral hypoplasia of the posterior communicating arteries (PCoAs) in order to provide a clue to neurosurgeons and neurologists in their work to diagnose and treat patients with stroke symptoms.

Material and methods: We performed an anatomical retrospective study on gross morphology of 98 circles of Willis (CW) that were identified at the time of the autopsies made on patients who have died in the "Prof. dr. N. Oblu” Emergency Clinical Hospital Iasi, Romania, the main neurological and neuro-surgical healthcare Centre in the region of North-Eastern Romania, for a period of three years. Demographical and autopsic data, as well as photographic images were taken from the registers and archives of the Pathology Department. Only CWs with bilateral hypoplasia of PCoA without any other associated anatomical abnormalities were studied.

Results: In 5 cases (5.12%) we identified bilateral hypoplasia of PCoAs. Male: Female ratio was 3: 2. The average age was 63.5 years. 80% of cases died of ischemic or haemorrhagic stroke, but 10% died of heart disease. In 2 (40%) cases, one of the two PCoAs presented aplasia and the other was hypoplastic, an event related to frontal lobe strokes on the same side. In the other two (40%) cases in which both arteries were hypoplastic, the cause of death was ischemic stroke located in the brainstem. In only one case (20%), even in the presence of bilateral hypoplasia of PCoAs, the cause of death was non-neurological.

Conclusion: Even if literature claims that PCoA hypoplasia becomes a risk factor for ischemic stroke only in the presence of ipsilateral internal carotid artery (ICA) occlusion, in our study we found that aplasia of one of the two PCoAs associated with hypoplasia of the controlateral artery caused ischemic stroke in the brainstem, thus revealing the role of PCoAs in ensuring the posterior circulation in case of occlusion of the vertebro-basilar system.