{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T01:53:22Z","timestamp":1790819602354,"version":"4.1.0"},"reference-count":25,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2019,7,3]],"date-time":"2019-07-03T00:00:00Z","timestamp":1562112000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Intracranial hemorrhage caused by the rupture of brain aneurysms occurs in almost 10 per 100,000 people whereas the incidence of such aneurysms is significantly higher, accounting for 4\u20139%. Linking certain factors to cerebral aneurysm rupture could help in explaining the significantly lower incidence of their rupture compared to their presence. The aim of this study is to determine the association between the corresponding circle of Willis configurations and rupture of cerebral aneurysms. Materials and Methods: A group of 114 patients treated operatively for aruptured cerebral aneurysm and a group of 56 autopsied subjects were involved in the study. Four basic types of the circle of Willis configurations were formed\u2014two symmetric types A and C, and two asymmetric types B and D. Results: A statistically significantly higher presence of asymmetry of the circle of Willis was determined in the group of surgically-treated subjects (p = 0.001),witha significant presence of asymmetric Type B in this group (p &lt; 0.001). The changeson the A1 segment in the group of surgically-treated subjects showed a statistically significant presence compared to the group of autopsied subjects (p = 0.001). Analyzing the presence of symmetry of the circle of Willis between the two groups, that is, the total presence of symmetric types A and C, indicated their statistically significant presence in the group of autopsied patients (p &lt; 0.001). Conclusions: Changes such as hypoplasia or aplasia of A1 and the resulting asymmetry of the circle of Willis directly affect the possibility of the rupture of cerebral aneurysms. Detection of the corresponding types of the circle of Willis after diagnostic examination can be the basis for the development of a protocol for monitoring such patients.<\/jats:p>","DOI":"10.3390\/medicina55070338","type":"journal-article","created":{"date-parts":[[2019,7,4]],"date-time":"2019-07-04T11:13:18Z","timestamp":1562238798000},"page":"338","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Association between Circle of Willis Configuration and Rupture of Cerebral Aneurysms"],"prefix":"10.3390","volume":"55","author":[{"given":"Neboj\u0161a N.","family":"Stojanovi\u0107","sequence":"first","affiliation":[{"name":"Clinic of Neurosurgery, Clinical Center Ni\u0161, Zorana \u0110in\u0111i\u0107a 48, 18000 Ni\u0161, Serbia"},{"name":"Faculty of Medicine, University of Ni\u0161, Zorana \u0110in\u0111i\u0107a 81,18000 Ni\u0161, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksandar","family":"Kosti\u0107","sequence":"additional","affiliation":[{"name":"Clinic of Neurosurgery, Clinical Center Ni\u0161, Zorana \u0110in\u0111i\u0107a 48, 18000 Ni\u0161, Serbia"},{"name":"Faculty of Medicine, University of Ni\u0161, Zorana \u0110in\u0111i\u0107a 81,18000 Ni\u0161, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radisav","family":"Miti\u0107","sequence":"additional","affiliation":[{"name":"Clinic of Neurosurgery, Clinical Center Ni\u0161, Zorana \u0110in\u0111i\u0107a 48, 18000 Ni\u0161, Serbia"},{"name":"Faculty of Medicine, University of Ni\u0161, Zorana \u0110in\u0111i\u0107a 81,18000 Ni\u0161, Serbia"},{"name":"Institute of Pathology, Clinical Center Ni\u0161, Zorana \u0110in\u0111i\u0107a 48, 18000 Ni\u0161, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1008-524X","authenticated-orcid":false,"given":"Luka","family":"Berila\u017ei\u0107","sequence":"additional","affiliation":[{"name":"Clinic of Neurosurgery, Clinical Center Ni\u0161, Zorana \u0110in\u0111i\u0107a 48, 18000 Ni\u0161, Serbia"},{"name":"Faculty of Medicine, University of Ni\u0161, Zorana \u0110in\u0111i\u0107a 81,18000 Ni\u0161, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mi\u0161a","family":"Radisavljevi\u0107","sequence":"additional","affiliation":[{"name":"Clinic of Neurosurgery, Clinical Center Ni\u0161, Zorana \u0110in\u0111i\u0107a 48, 18000 Ni\u0161, Serbia"},{"name":"Faculty of Medicine, University of Ni\u0161, Zorana \u0110in\u0111i\u0107a 81,18000 Ni\u0161, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,7,3]]},"reference":[{"key":"ref_1","first-page":"14","article-title":"Incidences of unruptured intracranial aneurysms and subarachnoid hemorrhage: Results of a statewide study","volume":"7","author":"Asaithambi","year":"2014","journal-title":"J. Vascinterv. Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1097\/ANA.0000000000000130","article-title":"Aneurysmal subarachnoid hemorrhage","volume":"27","year":"2015","journal-title":"J. Neurosurg. Anesth."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1161\/01.STR.29.1.251","article-title":"Prevalence and risk of rupture of intracranial aneurysms: A systematic review","volume":"29","author":"Rinkel","year":"1998","journal-title":"Stroke"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1725","DOI":"10.1056\/NEJM199812103392401","article-title":"The international study of unruptured intracranial aneurysms investigators: Unruptured intracranial aneurysms\u2014Risk of rupture and risks of surgical intervention","volume":"339","author":"Wiebers","year":"1998","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1572","DOI":"10.4065\/79.12.1572","article-title":"Pathogenesis, natural history, and treatment of unruptured intracranial aneurysms","volume":"79","author":"Wiebers","year":"2004","journal-title":"Mayo Clin. Proc."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1416","DOI":"10.1161\/01.STR.23.10.1416","article-title":"Impact of unruptured intracranial aneurysms on public health in the United States","volume":"23","author":"Wiebers","year":"1992","journal-title":"Stroke"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1016\/S1474-4422(11)70109-0","article-title":"Prevalence of unruptured intracranial aneurysms, with emphasis on sex, age, comorbidity, country, and time period: A systematic review and meta-analysis","volume":"10","author":"Vlak","year":"2011","journal-title":"Lancet Neurol."},{"key":"ref_8","first-page":"2423","article-title":"A comprehensive study of the anatomical variations of the circle of willis in adult human brains","volume":"7","author":"Iqbal","year":"2013","journal-title":"J.Clin. Diagn. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2086","DOI":"10.1161\/01.STR.27.11.2086","article-title":"Hemodynamic study of the anterior communicating artery","volume":"27","author":"Ujiie","year":"1996","journal-title":"Stroke"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/10255840008907996","article-title":"Coputational models of blood flow in the circle of Willis","volume":"4","author":"Ferrandez","year":"2000","journal-title":"Comput. Methods Biomech. Biomed. Eng."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1038\/jcbfm.2014.7","article-title":"Function of circle of Willis","volume":"34","author":"Vrselja","year":"2014","journal-title":"J. Cereb. Blood Flow Metab."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1570","DOI":"10.1177\/0271678X15626155","article-title":"Unilateral fetal-type circle of Willis anatomy causes right-left asymmetry in cerebral blood flow with pseudo-continuous arterial spin labeling: A limitation of arterial spin labeling-based cerebral blood flow measurements?","volume":"36","author":"Moonen","year":"2016","journal-title":"Sendto. J. Cereb.Blood Flow Metab."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1055\/s-2008-1053407","article-title":"Vascular variotions associated with anterior communicating artery aneurysms\u2014An intraoperative study","volume":"40","author":"Aydin","year":"1997","journal-title":"Minim. Invasive Neurosusrg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1007\/s00276-014-1313-7","article-title":"Anatomical variations of the anterior communicating artery complex: Gender relationship","volume":"37","author":"Tomaszewski","year":"2015","journal-title":"Surg. Radiol. Anat."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"83","DOI":"10.4314\/ahs.v14i1.13","article-title":"Relationship between the morphology of A-1 segment of anterior cerebral artery and anterior communicating artery aneurysms","volume":"14","author":"Feng","year":"2014","journal-title":"Afr. Health Sci."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"S10","DOI":"10.1186\/1475-925X-14-S1-S10","article-title":"Experimental study of hemodynamics in the circle of Willis","volume":"14","author":"Zhu","year":"2015","journal-title":"Biomed. Eng. Online"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1161\/01.STR.19.4.507","article-title":"Involvement of internal elastic lamina in development of induced cerebral aneurysms in rats","volume":"19","author":"Kim","year":"1988","journal-title":"Stroke"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1115\/1.2796097","article-title":"Experimental study of steady and pulsatile flows in cerebral aneurysm model of various sizes at branching site","volume":"119","author":"Liou","year":"1997","journal-title":"ASME J. Biomech. Eng."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"108","DOI":"10.3171\/jns.2004.101.1.0108","article-title":"Bifurcation geometry and the presence of cerebral artery aneurysms","volume":"101","author":"Ingebrigtsen","year":"2004","journal-title":"J. Neurosurg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1148\/radiol.2351031799","article-title":"Distribution of cerebral blood flow in the circle of Willis","volume":"235","author":"Hendrikse","year":"2005","journal-title":"Radiology"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Jin, Z., Dong, W., Cai, X., Zhang, Z., Zhang, L., Gao, F., Kang, X., Li, J., Wang, H., and Gao, N. (2016). CTA Characteristics of the Circle of Willis and Intracranial Aneurysm in a Chinese Crowd with Family History of Stroke. Biomed. Res. Int.","DOI":"10.1155\/2016\/1743794"},{"key":"ref_22","first-page":"86","article-title":"Evaluating the circle of Willis aneurysms location and relationship with its variations by multi detector CT Angiography","volume":"9","author":"Shakeri","year":"2013","journal-title":"J. Am. Sci."},{"key":"ref_23","first-page":"1","article-title":"Haemodynamic effect on the growth of experimentally indiced saccular aneurysms in rats","volume":"2","author":"Ersin","year":"2002","journal-title":"Ann. Neurosurg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"S11","DOI":"10.1186\/1475-925X-14-S1-S11","article-title":"A 3D numerical study of the collateral capacity of the circle of Willis with anatomical variation in the posterior circulation","volume":"14","author":"Ren","year":"2015","journal-title":"Biomed. Eng. Online"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1007\/s00415-009-0028-x","article-title":"Configuration of the circle of Willis, direction of flow, and shape of the aneurysm as risk factors for rupture of intracranial aneurysms","volume":"256","author":"Velthuis","year":"2009","journal-title":"J. Neurol."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/55\/7\/338\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:02:22Z","timestamp":1760187742000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/55\/7\/338"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,7,3]]},"references-count":25,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2019,7]]}},"alternative-id":["medicina55070338"],"URL":"https:\/\/doi.org\/10.3390\/medicina55070338","relation":{"has-preprint":[{"id-type":"doi","id":"10.20944\/preprints201904.0152.v1","asserted-by":"object"}]},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,7,3]]}}}