A Study of Collateral and Morphometric Correlation of Anatomical Variations in the Circle of Willis and Internal Carotid Artery in Acute Stroke in Elderly Subjects

Abstract

Background

The Circle of Willis (CoW) is a great architectural wonder that ensures adequate cerebral perfusion through collateral circulation. Anatomical variations in the CoW are common and may influence stroke susceptibility and outcomes, particularly in elderly populations. Despite global research, limited data exist on the association between CoW variations and stroke in the Indian geriatric population.

 Objectives

This case-control observational study aims to assess the association between anatomical variations in the Circle of Willis and internal carotid artery (ICA) with acute stroke in elderly Indian subjects (≥60 years) using Time-of-Flight Magnetic Resonance Angiography (TOF-MRA). Additionally, the study will develop a novel Asymmetry Index (AI) for vessel dominance assessment.

Methods

A total of 134 participants (67 cases with stroke and 67 age- and sex-matched controls) aged ≥60 years will be recruited from Datta Meghe Medical College and JNMC hospitals, Nagpur. TOF-MRA will be used to identify and classify CoW variations. Morphometric parameters, including vessel diameters, lengths, and asymmetry ratios, will be measured. Statistical analysis will determine associations between anatomical variations and stroke occurrence.

Expected Outcomes

The study will provide region-specific data on CoW variations in elderly Indians, establish correlations between anatomical variations and stroke risk, and introduce a novel Asymmetry Index for clinical application in stroke risk assessment.