{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T02:24:32Z","timestamp":1768875872188,"version":"3.49.0"},"reference-count":45,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T00:00:00Z","timestamp":1755475200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["NeuroSci"],"abstract":"<jats:p>Background: The literature shows that anterior communicating artery (AcoA) aneurysms are the most common intracranial aneurysms. To date, there has only been one postmortem study focused on the correlations between autopsy findings and imaging results in cases of intracranial aneurysms associated with anatomical variants of the circle of Willis (CW). Methods: We investigated the anatomical variants of the CW associated with the occurrence and rupture of AcoA aneurysms by performing comparative analyses, in the same patients, of postmortem autopsy data with antemortem computed tomography\u2013angiography (CTA) results obtained in the first 48 h after the onset of subarachnoid hemorrhage. Our retrospective observational study identified the anatomical variants of the CW at autopsy in 16 deceased adult Romanian patients with AcoA aneurysms over a 12-year period (2010\u20132022). Results: The autopsy findings revealed that the AcoA ruptured aneurysms had a mean external diameter of 9.50 mm, and 71.4% of them presented three or four anatomical variants inside the same CW. The initial antemortem CTA examination correctly located the AcoA aneurysms in all cases (100%), and an anatomical variant of the CW was only noted in 18.75% of patients. The final postmortem re-analyzed the same CTA images identified in all cases (100%), focusing on both the AcoA aneurysm and all anatomical variants of the CW found during the autopsies. Conclusions: Although it was previously thought that the occurrence of AcoA aneurysms is related only to the hemodynamic changes induced by the nearby arterial anatomical variants, we identified the simultaneous involvement of at least one hypoplastic artery and one or two PCA fetal-type anatomical variants that were located in both the anterior and posterior parts of the CW. Furthermore, if sufficient time is devoted to the CT\u2013angiography analysis and interpretation of the images, anatomical variants of the circle of Willis associated with AcoA aneurysms can be identified as accurately as they are in invasive postmortem autopsy examinations.<\/jats:p>","DOI":"10.3390\/neurosci6030081","type":"journal-article","created":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T16:22:33Z","timestamp":1755534153000},"page":"81","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Comparing Antemortem CT\u2013Angiography Data with Autopsy Findings in Regard to Anterior Communicating Artery Aneurysms"],"prefix":"10.3390","volume":"6","author":[{"given":"Ana Maria","family":"Dumitrescu","sequence":"first","affiliation":[{"name":"Department of Morpho-Functional Sciences I, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1485-0543","authenticated-orcid":false,"given":"Dragos Andrei","family":"Chiran","sequence":"additional","affiliation":[{"name":"Department of Morpho-Functional Sciences I, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristinel Ionel","family":"Stan","sequence":"additional","affiliation":[{"name":"Department of Morpho-Functional Sciences I, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cringuta Mariana","family":"Paraschiv","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences I, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Internal Medicine Clinic, Clinical CF Hospital, 700506 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicolaie","family":"Dobrin","sequence":"additional","affiliation":[{"name":"Neurointerventional Surgery Department, \u201cProf. Dr. N. Oblu\u201d Emergency Clinical Hospital, 700309 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandru","family":"Chiriac","sequence":"additional","affiliation":[{"name":"Neurointerventional Surgery Department, \u201cProf. Dr. N. Oblu\u201d Emergency Clinical Hospital, 700309 Iasi, Romania"},{"name":"Department of Surgery II, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5836-1322","authenticated-orcid":false,"given":"Maria Magdalena","family":"Leon","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences I, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucia Corina","family":"Dima-Cozma","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences I, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0402-060X","authenticated-orcid":false,"given":"Cristina Gena","family":"Dascalu","sequence":"additional","affiliation":[{"name":"Department of Medical Informatics and Biostatistics, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana Marina","family":"Radulescu","sequence":"additional","affiliation":[{"name":"Department of Morpho-Functional Sciences I, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roxana Florentina","family":"Gavril","sequence":"additional","affiliation":[{"name":"Department of Morpho-Functional Sciences I, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anca","family":"Sava","sequence":"additional","affiliation":[{"name":"Department of Morpho-Functional Sciences I, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Department of Pathology, \u201cProf. Dr. N. Oblu\u201d Emergency Clinical Hospital, 700309 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Chen, J., Li, M., Zhu, X., Chen, Y., Zhang, C., Shi, W., Chen, Q., and Wang, Y. (2020). Anterior communicating artery aneurysms: Anatomical considerations and microsurgical strategies. Front. Neurol., 11.","DOI":"10.3389\/fneur.2020.01020"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1016\/j.wneu.2019.10.027","article-title":"Differences in size between unruptured and ruptured saccular intracranial aneurysms by location","volume":"133","author":"Rinaldo","year":"2020","journal-title":"World Neurosurg."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"W\u00f3jtowicz, K., Przepiorka, L., Kujawski, S., Marchel, A., and Kunert, P. (2023). Unruptured anterior communicating artery aneurysms: Management strategy and results of a single-center experience. J. Clin. Med., 12.","DOI":"10.3390\/jcm12144619"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"66","DOI":"10.70594\/brain\/16.2\/5","article-title":"Circle of Willis Variants and Intracranial Aneurysm Risk: Evidence from an Autopsy-Based Study","volume":"16","author":"Dumitrescu","year":"2025","journal-title":"BRAIN Broad Res. Artif. Intell. Neurosci."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"68","DOI":"10.2214\/ajr.101.1.68","article-title":"Experience and result with postmortem cerebral angiography performed as routine procedure of the autopsy","volume":"101","author":"Wollschlaeger","year":"1967","journal-title":"Am. J. Roentgenol. Radium Ther. Nucl. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1093\/ejcts\/ezt103","article-title":"The role of Willis circle variations during unilateral selective cerebral perfusion: A study of 500 circles","volume":"44","author":"Papantchev","year":"2013","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_7","first-page":"9","article-title":"Congenital Absence of the Internal Carotid Artery","volume":"16","author":"Jeong","year":"2010","journal-title":"J. Soonchunhyang Med. Sci."},{"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","first-page":"276","article-title":"Bilateral hypoplasia of the posterior communicating artery: A morphological case report","volume":"7","author":"Nagawa","year":"2017","journal-title":"Anat. Physiol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Davidoiu, A.M., Minc\u0103, D.I., Rusu, M.C., Hostiuc, S., and Toader, C. (2023). The Fetal Type of Posterior Cerebral Artery. Medicina, 59.","DOI":"10.3390\/medicina59020231"},{"key":"ref_11","first-page":"105937","article-title":"Circle of Willis Variants: Fetal PCA","volume":"2013","author":"Shaban","year":"2013","journal-title":"Stroke Res. Treat."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"20","DOI":"10.2399\/ana.18.003","article-title":"Anatomical Variations of the Circle of Willis: Evaluation with CT Angiography","volume":"12","year":"2018","journal-title":"Anatomy"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1186\/s41983-023-00758-9","article-title":"Predictive value of the anterior communicating artery (ACoA) complex variations for the incidence and rupture of ACoA aneurysms","volume":"59","author":"Hassanin","year":"2023","journal-title":"Egypt. J. Neurol. Psychiatry Neurosurg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.4067\/S0717-95022017000300049","article-title":"Anatomical variants of anterior cerebral arterial circle. A study by multidetector computerized 3D tomographic angiography","volume":"35","year":"2017","journal-title":"Int. J. Morphol."},{"key":"ref_15","first-page":"39","article-title":"Investigation of morphology and anatomic variations of circle of Willis and measurement of diameter of cerebral arteries by 3D-TOF angiography","volume":"24","author":"He","year":"2007","journal-title":"Sheng Wu Yi Xue Gong Cheng Xue Za Zhi"},{"key":"ref_16","first-page":"2397","article-title":"Anterior communicating artery complex anatomy and its correlation with aneurysm formation","volume":"89","author":"Shadad","year":"2021","journal-title":"Med. J. Cairo Univ."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"371","DOI":"10.2147\/VHRM.S415213","article-title":"Clinical and morphological factors for ruptured anterior communicating artery aneurysms","volume":"19","author":"Rilianto","year":"2023","journal-title":"Vasc. Health Risk Manag."},{"key":"ref_18","first-page":"243","article-title":"The significance of lifestyle, associated diseases, and anatomical variants of the circle of Willis in the formation of Anterior Communicating Artery aneurysms","volume":"127","author":"Dumitrescu","year":"2023","journal-title":"Rev. Med. Chir. Soc. Med. Nat. Ia\u015fi"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"393","DOI":"10.31688\/ABMU.2018.53.3.13","article-title":"\u00c9valuation de la tension art\u00e9rielle et de la pression du pouls dans le syndrome m\u00e9tabolique","volume":"53","author":"Popa","year":"2018","journal-title":"Arch. Balk. Med. Union."},{"key":"ref_20","first-page":"427","article-title":"Flow Cytometry Analysis of PPAR\u03b1 Receptors in Metabolic Syndrome","volume":"22","author":"Popa","year":"2014","journal-title":"Rev. Rom. Med. Lab."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Nedelcu, A.H., Hutanu, A., Nedelcu, I., Partene Vicoleanu, S., Statescu, G., Gavril, L., Haliciu, A.M., Ursaru, M., and Tarniceriu, C.C. (2023). The Prevalence and Morphology-Wise Demographic Distribution of Ponticulus Posticus on CT Scans\u2014A Retrospective Observational Study. Medicina, 59.","DOI":"10.3390\/medicina59040650"},{"key":"ref_22","first-page":"173","article-title":"Middle turbinate pneumatization\u2014\u201cconcha bullosa\u201d. A narrative literature review and comprehensive developmental concepts","volume":"16","author":"Hurjui","year":"2024","journal-title":"Rom. J. Oral Rehabil."},{"key":"ref_23","first-page":"46","article-title":"Anatomo-morphological study and new original classification of concha bullosa","volume":"16","author":"Nedelcu","year":"2024","journal-title":"Rom. J. Oral Rehabil."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Nedelcu, A.H., Lupu, V.V., Lupu, A., Tepordei, R.T., Ioniuc, I., Stan, C.I., Partene Vicoleanu, S.A., Haliciu, A.M., Statescu, G., and Ursaru, M. (2024). Triangular fossa of the third cerebral ventricle\u2014An original 3D model and morphometric study. Front. Neuroanat., 18.","DOI":"10.3389\/fnana.2024.1398858"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"395","DOI":"10.47162\/RJME.63.2.10","article-title":"Anatomical study of circle of Willis on fresh autopsied brains. A study of a Romanian population","volume":"63","author":"Dumitrescu","year":"2022","journal-title":"Rom. J. Morphol. Embryol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1590\/1806-9282.20210293","article-title":"The relationship between smoking and brain aneurysms: From formation to rupture","volume":"67","author":"Bennett","year":"2021","journal-title":"Rev. Assoc. Med. Bras."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Lin, H., Yin, Y., Li, J., Liu, S., Long, X., and Liao, Z. (2024). Exploring the causal links between cigarette smoking, alcohol consumption, and aneurysmal subarachnoid hemorrhage: A two-sample Mendelian randomization analysis. Front. Nutr., 11.","DOI":"10.3389\/fnut.2024.1397776"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Feng, X., Qian, Z., Zhang, B., Guo, E., Wang, L., Liu, P., Wen, X., Xu, W., Jiang, C., and Li, Y. (2018). Number of Cigarettes Smoked Per Day, Smoking Index, and Intracranial Aneurysm Rupture: A Case\u2013Control Study. Front. Neurol., 9.","DOI":"10.3389\/fneur.2018.00380"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1007\/s10143-017-0932-y","article-title":"\u201cCoil mainly\u201d policy in management of intracranial ACoA aneurysms: Single-centre experience with the systematic review of literature and meta-analysis","volume":"41","author":"Steklacova","year":"2018","journal-title":"Neurosurg. Rev."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1016\/j.wneu.2017.08.086","article-title":"Association of perforator infarction with clinical courses and outcomes following surgical clipping of ruptured anterior communicating artery aneurysms","volume":"107","author":"Yamamoto","year":"2017","journal-title":"World Neurosurg."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"International Study of Unruptured Intracranial Aneurysms Investigators (1998). Unruptured intracranial aneurysms-risk of rupture and risks of surgical intervention. N. Engl. J. Med., 339, 1725\u20131733.","DOI":"10.1056\/NEJM199812103392401"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"3018","DOI":"10.1161\/STROKEAHA.113.001667","article-title":"Risk of rupture of small anterior communicating artery aneurysms is similar to posterior circulation aneurysms","volume":"44","author":"Bijlenga","year":"2013","journal-title":"Stroke"},{"key":"ref_33","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."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1136\/jnis.2010.004358","article-title":"The role of circle of Willis anomalies in cerebral aneurysm rupture","volume":"4","author":"Lazzaro","year":"2012","journal-title":"J. Neurointerv. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Feng, L., Mao, H.-J., Zhang, D.-D., Zhu, Y.-C., and Han, F. (2023). Anatomical variations in the circle of Willis and the formation and rupture of intracranial aneurysms: A systematic review and meta-analysis. Front. Neurol., 13.","DOI":"10.3389\/fneur.2022.1098950"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"107815","DOI":"10.1016\/j.clineuro.2023.107815","article-title":"Fetal-type posterior cerebral artery and association of rupture in posterior communicating artery aneurysms: A systematic review and meta-analysis","volume":"231","year":"2023","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1551","DOI":"10.3174\/ajnr.A3991","article-title":"Effects of circle of Willis anatomic variations on angiographic and clinical outcomes of coiled anterior communicating artery aneurysms","volume":"35","author":"Tarulli","year":"2014","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e155","DOI":"10.1016\/j.wneu.2021.06.151","article-title":"Morphologic variations in the circle of Willis as a risk factor for aneurysm rupture in the anterior and posterior communicating arteries","volume":"154","author":"Oberman","year":"2021","journal-title":"World Neurosurg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1016\/j.wneu.2017.07.122","article-title":"Relationship of A1 segment hypoplasia with the radiologic and clinical outcomes of surgical clipping of anterior communicating artery aneurysms","volume":"106","author":"Yang","year":"2017","journal-title":"World Neurosurg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"89","DOI":"10.3171\/2016.7.JNS16736","article-title":"Relationship of A1 segment hypoplasia to anterior communicating artery aneurysm morphology and risk factors for aneurysm formation","volume":"127","author":"Rinaldo","year":"2017","journal-title":"J. Neurosurg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"3093","DOI":"10.5455\/annalsmedres.2020.07.795","article-title":"Intracranial arterial variations and their relation with cerebral aneurysms: Analysis of 640 patients","volume":"27","author":"Uyanik","year":"2020","journal-title":"Ann. Med. Res."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e59","DOI":"10.1016\/j.wneu.2021.06.007","article-title":"Analysis of risk factors for anterior communicating artery aneurysm rupture: A single-center study","volume":"153","author":"Zhang","year":"2021","journal-title":"World Neurosurg."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Negatie, H.M., Kebede, M.A., Abate, A.D., Admassie, S.H., Worku, A.B., Ahmed, H.T., Mesfine, Y.Y., and Melak, M.M. (2025). Association of circle of Willis variants with stroke and aneurysm: Insights from a tertiary hospital in Ethiopia. BMC Neurol., 25.","DOI":"10.1186\/s12883-025-04082-y"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.jocn.2023.02.008","article-title":"Risk factors for the rupture of anterior communicating artery aneurysms: Coexistence of fetal-type posterior cerebral artery and A1 segment hypoplasia\/agenesis","volume":"110","author":"Kaya","year":"2023","journal-title":"J. Clin. Neurosci."},{"key":"ref_45","first-page":"192","article-title":"Aneurysm of the Anterior Communicating Artery Associated with Multiple Anatomical Variants of the Circle of Willis. A Case Report and Literature Review","volume":"19","author":"Dumitrescu","year":"2020","journal-title":"Rom. J. Funct. Clin. Macro-Microsc. Anat. Anthropol."}],"container-title":["NeuroSci"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2673-4087\/6\/3\/81\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:29:48Z","timestamp":1760034588000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2673-4087\/6\/3\/81"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,18]]},"references-count":45,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["neurosci6030081"],"URL":"https:\/\/doi.org\/10.3390\/neurosci6030081","relation":{},"ISSN":["2673-4087"],"issn-type":[{"value":"2673-4087","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,18]]}}}