Circulus Willis Anomalies Diagnosed with CT Angiography and Evaluation of Their Relations with Ischemic Stroke

Halil Ay

doi:10.37989/gumussagbil.1372783

Research Article

BT Anjiyografi ile Teşhis Edilen Circulus Willis Anomalileri ve İskemik İnme ile İlişkilerinin Değerlendirilmesi

Year 2023, Volume: 12 Issue: 4, 1924 - 1929, 26.12.2023

Halil Ay

https://doi.org/10.37989/gumussagbil.1372783

Abstract

Bu çalışmadaki amacımız Bilgisayarlı Tomografi Anjiyografi (BTA) incelemelerini retrospektif olarak analiz ederek Posterior Komünikan Arter (PCoM), Anterior Serebral Arter A1 segmenti (ACA AI) ve Fetal Tip Posterior Serebral Arter (FPCA) anomalilerinin sıklığını ve iskemik inme üzerindeki etkilerini incelemektir. Çalışma retrospektif olarak planlandı ve 2017 yılında BTA çekilen hastalar çalışmaya dahil edildi. Bilateral hipoplastik/aplastik PCoA anomalisi tanısı alan 22 olguya (%26,5) anterior sirkülasyon infraktı, 24 olguya (%28,9) posterior sirkülasyon infraktı tanısı konulmuştur, 37 olguya (%44,6) %) iskemik inme tanısı konulmamıştır. Tek taraflı hipoplastik/aplastik PCoA anomalisi olan olguların 17'sine (%37,8) anterior sirkülasyon enfarktı, 14 olguya (%31,1) posterior sirkülasyon enfarktı tanısı konulmuştur. Tek taraflı hipoplastik/aplastik ACA A1 segmenti tanısı alan 50 olgunun 13'üne (%26) anterior sirkülasyon infraktı, 10 olguya (%20) posterior sirkülasyon infraktı tanısı konulmuştur. 27 olguya (%54) iskemik inme tanısı konulmamıştır. Bilateral hipoplastik/aplastik ACA A1 segmenti tanısı alan 2 olgunun her ikisinde de anterior sirkülasyon infarktı mevcuttu. Tek taraflı FPCA anomalisi tanısı alan 13 olgunun 4'üne (%30,8) anterior sirkülasyon enfarktı tanısı konulmuştur, 3 olguya (%23,1) posterior sirkülasyon enfarktüsü tanısı konulurken, 6 olguda (%46,2) iskemik inme semptomu saptanmamıştır. Sonuç olarak, bir veya daha fazla inme risk faktörüne sahip bireylerde bu varyasyonların optimum inme profilaksisindeki rolü henüz belirlenmemiş olsa da, klinik araştırmacıların gelecekteki çalışmalarda bu belirsizlikleri ortadan kaldıracağından şüphe yoktur.

Keywords

Anterior Serebral Arter, Bilgisayarlı Tomografi Anjiyografi, İnme, Posterior Komminikan Arter.

References

1. Willis, C. A. D. T. (1997). “The Origins of Clinical Neuroscience”. Cambridge: Plumridge.
2. Krishnaswamy, A., Klein, J. P., and Kapadia, S. R. (2010). “Clinical cerebrovascular anatomy”. Catheterization and Cardiovascular Interventions, 75(4), 530-539. https://doi.org/10.1002/ccd.22299
3. Mull, M., Schwarz, M., and Thron, A. (1997). “Cerebral hemispheric low-flow infarcts in arterial occlusive disease: lesion patterns and angiomorphological conditions”. Stroke, 28(1), 118-123. https://doi.org/10.1161/01.STR.28.1.118
4. Miralles, M., Dolz, J. L., Cotillas, J., Aldoma, J., Santiso, M. A., Gimenez, A., ... and Cairols, M. A. (1995). “The role of the circle of Willis in carotid occlusion: assessment with phase contrast MR angiography and transcranial duplex”. European Journal of Vascular and Endovascular Surgery, 10(4), 424-430. https://doi.org/10.1016/S1078-5884(05)80164-9
5. Drayer, B. P., and Djang, W. T. (1990). “Physiological considerations in extra and intracranial vascular disease. Radiology-diagnosis-imaging-intervention”. Philadelphia: JB Lippincott Company, 1-10.
6. Hedera, P., Bujdakova, J., Traubner, P., and Pancak, J. (1998). “Stroke risk factors and development of collateral flow in carotid occlusive disease”. Acta Neurologica Scandinavica, 98(3), 182-186. https://doi.org/10.1111/j.1600-0404.1998.tb07291.x
7. van Everdinge, K. J., Visser, G. H., Klijn, C. J. M., Kappelle, L. J., and Van der Grond, J. (1998). “Role of collateral flow on cerebral hemodynamics in patients with unilateral internal carotid artery occlusion”. Annals of Neurology, 44(2), 167-176. https://doi.org/10.1002/ana.410440206
8. Alnæs, M. S., Isaksen, J., Mardal, K. A., Romner, B., Morgan, M. K., and Ingebrigtsen, T. (2007). “Computation of hemodynamics in the circle of Willis”. Stroke, 38(9), 2500-2505. https://doi.org/10.1161/STROKEAHA.107.482471
9. de Boorder, M. J., van der Grond, J., van Dongen, A. J., Klijn, C. J., Jaap Kappelle, L., Van Rijk, P. P., and Hendrikse, J. (2006). “Spect measurements of regional cerebral perfusion and carbondioxide reactivity: correlation with cerebral collaterals in internal carotid artery occlusive disease”. Journal of Neurology, 253, 1285-1291.
10. Arteaga, D. F., Strother, M. K., Davis, L. T., Fusco, M. R., Faraco, C. C., Roach, B. A., ... and Donahue, M. J. (2017). “Planning-free cerebral blood flow territory mapping in patients with intracranial arterial stenosis”. Journal of Cerebral Blood Flow and Metabolism, 37(6), 1944-1958. https://doi.org/10.1177/0271678X16657573
11. Arjal, R. K., Zhu, T., and Zhou, Y. (2014). “The study of fetal-type posterior cerebral circulation on multislice CT angiography and its influence on cerebral ischemic strokes”. Clinical Imaging, 38(3), 221-225. https://doi.org/10.1016/j.clinimag.2014.01.007
12. Lv, X., Li, Y., Yang, X., Jiang, C., and Wu, Z. (2012). “Potential proneness of fetal-type posterior cerebral artery to vascular insufficiency in parent vessel occlusion of distal posterior cerebral artery aneurysms”. Journal of Neurosurgery, 117(2), 284-287. https://doi.org/10.3171/2012.4.JNS111788
13. Van Raamt, A. F., Mali, W. P., Van Laar, P. J., and Van Der Graaf, Y. (2006). “The fetal variant of the circle of Willis and its influence on the cerebral collateral circulation”. Cerebrovascular Diseases, 22(4), 217-224. https://doi.org/10.1159/000094007
14. Diogo, M. C., Fragata, I., Dias, S. P., Nunes, J., Pamplona, J., and Reis, J. (2017). “Low prevalence of fetal-type posterior cerebral artery in patients with basilar tip aneurysms”. Journal of NeuroInterventional Surgery, 9(7), 698-701. https://doi.org/10.1136/neurintsurg-2016-012503
15. Kolukısa, M., Gürsoy, A. E., Kocaman, G., Dürüyen, H., Toprak, H., and Asil, T. (2015). “Carotid endarterectomy in a patient with posterior cerebral artery infarction: influence of fetal type PCA on atypical clinical course”. Case Reports in Neurological Medicine, 2015. https://doi.org/10.1155/2015/191202
16. Hoksbergen, A. W. J., Legemate, D. A., Csiba, L., Csati, G., Siro, P., and Fülesdi, B. (2003). “Absent collateral function of the circle of Willis as risk factor for ischemic stroke”. Cerebrovascular Diseases, 16(3), 191-198. https://doi.org/10.1159/000071115
17. Zhou, H., Sun, J., Ji, X., Lin, J., Tang, S., Zeng, J., and Fan, Y. H. (2016). “Correlation between the integrity of the circle of Willis and the severity of initial noncardiac cerebral infarction and clinical prognosis”. Medicine, 95(10). https://doi.org/10.1097%2FMD.0000000000002892
18. Harrison, M. J., and Marshall, J. O. H. N. (1988). “The variable clinical and CT findings after carotid occlusion: the role of collateral blood supply”. Journal of Neurology, Neurosurgery and Psychiatry, 51(2), 269-272. https://doi.org/10.1136/jnnp.51.2.269
19. Alpers, B. J., and Berry, R. G. (1963). “Circle of Willis in cerebral vascular disorders: the anatomical structure”. Archives of Neurology, 8(4), 398-402.
20. Puchades‐Orts, A., Nombela‐Gomez, M., and Ortuño‐Pacheco, G. (1976). “Variation in form of circle of Willis: some anatomical and embryological considerations”. The Anatomical Record, 185(1), 119-123. https://doi.org/10.1002/ar.1091850112
21. Waaijer, A., Van Leeuwen, M. S., Van der Worp, H. B., Verhagen, H. J. M., Mali, W. P. T. M., and Velthuis, B. K. (2007). “Anatomic variations in the circle of Willis in patients with symptomatic carotid artery stenosis assessed with multidetector row CT angiography”. Cerebrovascular Diseases, 23(4), 267-274. https://doi.org/10.1159/000098326
22. Wholey, M. W. A., Nowak, I., and Wu, W. C. L. (2009). “CTA and the Circle of Willis. Early use of multislice CTA to evaluate the distal internal carotid artery and the Circle of Willis and their correlation with stroke”. Endovascular Today, 7, 33-44.
23. van der Lugt, A., Buter, T. C., Govaere, F., Siepman, D. A. M., Tanghe, H. L. J., and Dippel, D. W. J. (2004). “Accuracy of CT angiography in the assessment of a fetal origin of the posterior cerebral artery”. European Radiology, 14, 1627-1633. https://doi.org/10.1007/s00330-004-2333-1
24. Jayaraman, M. V., Mayo-Smith, W. W., Tung, G. A., Haas, R. A., Rogg, J. M., Mehta, N. R., and Doberstein, C. E. (2004). “Detection of intracranial aneurysms: multi–detector row CT angiography compared with DSA”. Radiology, 230(2), 510-518. https://doi.org/10.1148/radiol.2302021465
25. Liebeskind, D. S., and Caplan, L. R. (2016). “Intracranial arteries-anatomy and collaterals”. Intracranial Atherosclerosis: Pathophysiology, Diagnosis and Treatment, 40, 1-20. https://doi.org/10.1159/000448264
26. Zaninovich, O. A., Ramey, W. L., Walter, C. M., and Dumont, T. M. (2017). “Completion of the circle of Willis varies by gender, age, and indication for computed tomography angiography”. World Neurosurgery, 106, 953-963. https://doi.org/10.1016/j.wneu.2017.07.084
27. Kluytmans, M., Van der Grond, J., Van Everdingen, K. J., Klijn, C. J. M., Kappelle, L. J., and Viergever, M. A. (1999). “Cerebral hemodynamics in relation to patterns of collateral flow”. Stroke, 30(7), 1432-1439. https://doi.org/10.1161/01.STR.30.7.1432
28. Chuang, Y. M., Liu, C. Y., Pan, P. J., ve Lin, C. P. (2007). “Anterior cerebral artery A1 segment hypoplasia may contribute to A1 hypoplasia syndrome”. European Neurology, 57(4), 208-211. https://doi.org/10.1159/000099160
29. Gerstner, E., Liberato, B., ve Wright, C. B. (2005). “Bi-hemispheric anterior cerebral artery with drop attacks and limb shaking TIAs”. Neurology, 65(1), 174-174. https://doi.org/10.1212/01.wnl.0000167551.36294.04
30. Mäurer, J., Mäurer, E., ve Perneczky, A. (1991). “Surgically verified variations in the A1 segment of the anterior cerebral artery: report of two cases”. Journal of Neurosurgery, 75(6), 950-953. https://doi.org/10.3171/jns.1991.75.6.0950
31. Kovač, J. D., Stanković, A., Stanković, D., Kovač, B., ve Šaranović, D. (2014). “Intracranial arterial variations: a comprehensive evaluation using CT angiography”. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research, 20, 420. https://doi.org/10.12659%2FMSM.890265
32. Yang, J. H., Choi, H. Y., Nam, H. S., Kim, S. H., Han, S. W., ve Heo, J. H. (2007). “Mechanism of infarction involving ipsilateral carotid and posterior cerebral artery territories”. Cerebrovascular Diseases, 24(5), 445-451. https://doi.org/10.1159/000108435
33. Eswaradass, P. V., Ramasamy, B., Ramadoss, K., ve Gnanashanmugham, G. (2015). “Can internal carotid artery occlusion produce simultaneous anterior and posterior circulation stroke?”. Indian Journal of Vascular and Endovascular Surgery, 2(3), 130-132. https://doi.org/10.4103/0972-0820.166934

Circulus Willis Anomalies Diagnosed with CT Angiography and Evaluation of Their Relations with Ischemic Stroke

Year 2023, Volume: 12 Issue: 4, 1924 - 1929, 26.12.2023

Halil Ay

https://doi.org/10.37989/gumussagbil.1372783

Abstract

Our aim in this study is examining the frequency of posterior communicating artery (PCoM), Anterior Cerebral Artery A1 segment (ACA AI) and Fetal type posterior cerebral artery (FPCA) anomalies and their effects on ischemic stroke by retrospectively analyzing examinations of Computerized Tomography Angiography (CTA) taken in our hospital within 2017. 22 cases (26.5%) diagnosed with bilateral hypoplastic / aplastic PCoA anomaly, were diagnosed with anterior circulation infarct, 24 cases (28.9%) were diagnosed with posterior circulation infarct, but 37 cases (44.6%) were not diagnosed with ischemic stroke. 17 (37.8%) of the cases who have unilateral hypoplastic / aplastic PCoA anomaly, were diagnosed with anterior circulation infarct, 14 cases (31.1%) were diagnosed with posterior circulation infarct. 13 (26%) of 50 cases diagnosed with unilateral hypoplastic / aplastic ACA A1 segment, were diagnosed with anterior circulation infarct, 10 cases (20%) were diagnosed with posterior circulation infarct. 27 cases (54%) were not diagnosed with ischemic stroke. Both of 2 cases diagnosed with bilateral hypoplastic / aplastic ACA A1 segment, had anterior circulation infarct. 4 (30.8%) of 13 cases diagnosed with unilateral FPCA anomaly, were diagnosed with anterior circulation infarct, 3 cases (23.1%) were diagnosed with posterior circulation infarct, 6 cases (46.2%) did not have ischemic stroke symptoms. In conclusion, even though these variations’ role in optimum stroke prophylaxis in individuals having one or more stroke risk factors, has not determined yet, there is no doubt that clinical researcher will eliminate these uncertainties in future studies.

Keywords

Anterior Cerebral Artery, Computerized Tomography Angiography, Stroke, Posterior Communicating Artery

References

1. Willis, C. A. D. T. (1997). “The Origins of Clinical Neuroscience”. Cambridge: Plumridge.
2. Krishnaswamy, A., Klein, J. P., and Kapadia, S. R. (2010). “Clinical cerebrovascular anatomy”. Catheterization and Cardiovascular Interventions, 75(4), 530-539. https://doi.org/10.1002/ccd.22299
3. Mull, M., Schwarz, M., and Thron, A. (1997). “Cerebral hemispheric low-flow infarcts in arterial occlusive disease: lesion patterns and angiomorphological conditions”. Stroke, 28(1), 118-123. https://doi.org/10.1161/01.STR.28.1.118
4. Miralles, M., Dolz, J. L., Cotillas, J., Aldoma, J., Santiso, M. A., Gimenez, A., ... and Cairols, M. A. (1995). “The role of the circle of Willis in carotid occlusion: assessment with phase contrast MR angiography and transcranial duplex”. European Journal of Vascular and Endovascular Surgery, 10(4), 424-430. https://doi.org/10.1016/S1078-5884(05)80164-9
5. Drayer, B. P., and Djang, W. T. (1990). “Physiological considerations in extra and intracranial vascular disease. Radiology-diagnosis-imaging-intervention”. Philadelphia: JB Lippincott Company, 1-10.
6. Hedera, P., Bujdakova, J., Traubner, P., and Pancak, J. (1998). “Stroke risk factors and development of collateral flow in carotid occlusive disease”. Acta Neurologica Scandinavica, 98(3), 182-186. https://doi.org/10.1111/j.1600-0404.1998.tb07291.x
7. van Everdinge, K. J., Visser, G. H., Klijn, C. J. M., Kappelle, L. J., and Van der Grond, J. (1998). “Role of collateral flow on cerebral hemodynamics in patients with unilateral internal carotid artery occlusion”. Annals of Neurology, 44(2), 167-176. https://doi.org/10.1002/ana.410440206
8. Alnæs, M. S., Isaksen, J., Mardal, K. A., Romner, B., Morgan, M. K., and Ingebrigtsen, T. (2007). “Computation of hemodynamics in the circle of Willis”. Stroke, 38(9), 2500-2505. https://doi.org/10.1161/STROKEAHA.107.482471
9. de Boorder, M. J., van der Grond, J., van Dongen, A. J., Klijn, C. J., Jaap Kappelle, L., Van Rijk, P. P., and Hendrikse, J. (2006). “Spect measurements of regional cerebral perfusion and carbondioxide reactivity: correlation with cerebral collaterals in internal carotid artery occlusive disease”. Journal of Neurology, 253, 1285-1291.
10. Arteaga, D. F., Strother, M. K., Davis, L. T., Fusco, M. R., Faraco, C. C., Roach, B. A., ... and Donahue, M. J. (2017). “Planning-free cerebral blood flow territory mapping in patients with intracranial arterial stenosis”. Journal of Cerebral Blood Flow and Metabolism, 37(6), 1944-1958. https://doi.org/10.1177/0271678X16657573
11. Arjal, R. K., Zhu, T., and Zhou, Y. (2014). “The study of fetal-type posterior cerebral circulation on multislice CT angiography and its influence on cerebral ischemic strokes”. Clinical Imaging, 38(3), 221-225. https://doi.org/10.1016/j.clinimag.2014.01.007
12. Lv, X., Li, Y., Yang, X., Jiang, C., and Wu, Z. (2012). “Potential proneness of fetal-type posterior cerebral artery to vascular insufficiency in parent vessel occlusion of distal posterior cerebral artery aneurysms”. Journal of Neurosurgery, 117(2), 284-287. https://doi.org/10.3171/2012.4.JNS111788
13. Van Raamt, A. F., Mali, W. P., Van Laar, P. J., and Van Der Graaf, Y. (2006). “The fetal variant of the circle of Willis and its influence on the cerebral collateral circulation”. Cerebrovascular Diseases, 22(4), 217-224. https://doi.org/10.1159/000094007
14. Diogo, M. C., Fragata, I., Dias, S. P., Nunes, J., Pamplona, J., and Reis, J. (2017). “Low prevalence of fetal-type posterior cerebral artery in patients with basilar tip aneurysms”. Journal of NeuroInterventional Surgery, 9(7), 698-701. https://doi.org/10.1136/neurintsurg-2016-012503
15. Kolukısa, M., Gürsoy, A. E., Kocaman, G., Dürüyen, H., Toprak, H., and Asil, T. (2015). “Carotid endarterectomy in a patient with posterior cerebral artery infarction: influence of fetal type PCA on atypical clinical course”. Case Reports in Neurological Medicine, 2015. https://doi.org/10.1155/2015/191202
16. Hoksbergen, A. W. J., Legemate, D. A., Csiba, L., Csati, G., Siro, P., and Fülesdi, B. (2003). “Absent collateral function of the circle of Willis as risk factor for ischemic stroke”. Cerebrovascular Diseases, 16(3), 191-198. https://doi.org/10.1159/000071115
17. Zhou, H., Sun, J., Ji, X., Lin, J., Tang, S., Zeng, J., and Fan, Y. H. (2016). “Correlation between the integrity of the circle of Willis and the severity of initial noncardiac cerebral infarction and clinical prognosis”. Medicine, 95(10). https://doi.org/10.1097%2FMD.0000000000002892
18. Harrison, M. J., and Marshall, J. O. H. N. (1988). “The variable clinical and CT findings after carotid occlusion: the role of collateral blood supply”. Journal of Neurology, Neurosurgery and Psychiatry, 51(2), 269-272. https://doi.org/10.1136/jnnp.51.2.269
19. Alpers, B. J., and Berry, R. G. (1963). “Circle of Willis in cerebral vascular disorders: the anatomical structure”. Archives of Neurology, 8(4), 398-402.
20. Puchades‐Orts, A., Nombela‐Gomez, M., and Ortuño‐Pacheco, G. (1976). “Variation in form of circle of Willis: some anatomical and embryological considerations”. The Anatomical Record, 185(1), 119-123. https://doi.org/10.1002/ar.1091850112
21. Waaijer, A., Van Leeuwen, M. S., Van der Worp, H. B., Verhagen, H. J. M., Mali, W. P. T. M., and Velthuis, B. K. (2007). “Anatomic variations in the circle of Willis in patients with symptomatic carotid artery stenosis assessed with multidetector row CT angiography”. Cerebrovascular Diseases, 23(4), 267-274. https://doi.org/10.1159/000098326
22. Wholey, M. W. A., Nowak, I., and Wu, W. C. L. (2009). “CTA and the Circle of Willis. Early use of multislice CTA to evaluate the distal internal carotid artery and the Circle of Willis and their correlation with stroke”. Endovascular Today, 7, 33-44.
23. van der Lugt, A., Buter, T. C., Govaere, F., Siepman, D. A. M., Tanghe, H. L. J., and Dippel, D. W. J. (2004). “Accuracy of CT angiography in the assessment of a fetal origin of the posterior cerebral artery”. European Radiology, 14, 1627-1633. https://doi.org/10.1007/s00330-004-2333-1
24. Jayaraman, M. V., Mayo-Smith, W. W., Tung, G. A., Haas, R. A., Rogg, J. M., Mehta, N. R., and Doberstein, C. E. (2004). “Detection of intracranial aneurysms: multi–detector row CT angiography compared with DSA”. Radiology, 230(2), 510-518. https://doi.org/10.1148/radiol.2302021465
25. Liebeskind, D. S., and Caplan, L. R. (2016). “Intracranial arteries-anatomy and collaterals”. Intracranial Atherosclerosis: Pathophysiology, Diagnosis and Treatment, 40, 1-20. https://doi.org/10.1159/000448264
26. Zaninovich, O. A., Ramey, W. L., Walter, C. M., and Dumont, T. M. (2017). “Completion of the circle of Willis varies by gender, age, and indication for computed tomography angiography”. World Neurosurgery, 106, 953-963. https://doi.org/10.1016/j.wneu.2017.07.084
27. Kluytmans, M., Van der Grond, J., Van Everdingen, K. J., Klijn, C. J. M., Kappelle, L. J., and Viergever, M. A. (1999). “Cerebral hemodynamics in relation to patterns of collateral flow”. Stroke, 30(7), 1432-1439. https://doi.org/10.1161/01.STR.30.7.1432
28. Chuang, Y. M., Liu, C. Y., Pan, P. J., ve Lin, C. P. (2007). “Anterior cerebral artery A1 segment hypoplasia may contribute to A1 hypoplasia syndrome”. European Neurology, 57(4), 208-211. https://doi.org/10.1159/000099160
29. Gerstner, E., Liberato, B., ve Wright, C. B. (2005). “Bi-hemispheric anterior cerebral artery with drop attacks and limb shaking TIAs”. Neurology, 65(1), 174-174. https://doi.org/10.1212/01.wnl.0000167551.36294.04
30. Mäurer, J., Mäurer, E., ve Perneczky, A. (1991). “Surgically verified variations in the A1 segment of the anterior cerebral artery: report of two cases”. Journal of Neurosurgery, 75(6), 950-953. https://doi.org/10.3171/jns.1991.75.6.0950
31. Kovač, J. D., Stanković, A., Stanković, D., Kovač, B., ve Šaranović, D. (2014). “Intracranial arterial variations: a comprehensive evaluation using CT angiography”. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research, 20, 420. https://doi.org/10.12659%2FMSM.890265
32. Yang, J. H., Choi, H. Y., Nam, H. S., Kim, S. H., Han, S. W., ve Heo, J. H. (2007). “Mechanism of infarction involving ipsilateral carotid and posterior cerebral artery territories”. Cerebrovascular Diseases, 24(5), 445-451. https://doi.org/10.1159/000108435
33. Eswaradass, P. V., Ramasamy, B., Ramadoss, K., ve Gnanashanmugham, G. (2015). “Can internal carotid artery occlusion produce simultaneous anterior and posterior circulation stroke?”. Indian Journal of Vascular and Endovascular Surgery, 2(3), 130-132. https://doi.org/10.4103/0972-0820.166934

There are 33 citations in total.

Details

Primary Language	English
Subjects	Emergency Medicine, Intensive Care
Journal Section	Original Article
Authors	Halil Ay 0000-0001-7233-7698
Publication Date	December 26, 2023
Published in Issue	Year 2023 Volume: 12 Issue: 4

Cite

APA	Ay, H. (2023). Circulus Willis Anomalies Diagnosed with CT Angiography and Evaluation of Their Relations with Ischemic Stroke. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, 12(4), 1924-1929. https://doi.org/10.37989/gumussagbil.1372783
AMA	Ay H. Circulus Willis Anomalies Diagnosed with CT Angiography and Evaluation of Their Relations with Ischemic Stroke. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi. December 2023;12(4):1924-1929. doi:10.37989/gumussagbil.1372783
Chicago	Ay, Halil. “Circulus Willis Anomalies Diagnosed With CT Angiography and Evaluation of Their Relations With Ischemic Stroke”. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi 12, no. 4 (December 2023): 1924-29. https://doi.org/10.37989/gumussagbil.1372783.
EndNote	Ay H (December 1, 2023) Circulus Willis Anomalies Diagnosed with CT Angiography and Evaluation of Their Relations with Ischemic Stroke. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi 12 4 1924–1929.
IEEE	H. Ay, “Circulus Willis Anomalies Diagnosed with CT Angiography and Evaluation of Their Relations with Ischemic Stroke”, Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, vol. 12, no. 4, pp. 1924–1929, 2023, doi: 10.37989/gumussagbil.1372783.
ISNAD	Ay, Halil. “Circulus Willis Anomalies Diagnosed With CT Angiography and Evaluation of Their Relations With Ischemic Stroke”. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi 12/4 (December 2023), 1924-1929. https://doi.org/10.37989/gumussagbil.1372783.
JAMA	Ay H. Circulus Willis Anomalies Diagnosed with CT Angiography and Evaluation of Their Relations with Ischemic Stroke. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi. 2023;12:1924–1929.
MLA	Ay, Halil. “Circulus Willis Anomalies Diagnosed With CT Angiography and Evaluation of Their Relations With Ischemic Stroke”. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, vol. 12, no. 4, 2023, pp. 1924-9, doi:10.37989/gumussagbil.1372783.
Vancouver	Ay H. Circulus Willis Anomalies Diagnosed with CT Angiography and Evaluation of Their Relations with Ischemic Stroke. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi. 2023;12(4):1924-9.

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