Cor Vasa 2016, 58(6):e591-e599 | DOI: 10.1016/j.crvasa.2015.11.008

Diagnostic value of color-coded duplex sonography in patients with ischemic stroke and congenital changes in the circle of Willis

Ivan Staikov^a,*, Ivan Stoyanov^a, Milena Staneva^b, Neyko Neykov^a, Galina Kirova^d, Petar Polomski^c, Ivo Petrov^c

^a Clinic of Neurology, Tokuda Hospital, Sofia, Bulgaria

^b Clinic of Vascular Surgery and Angiology, Tokuda Hospital, Sofia, Bulgaria

^c Department of Invasive Cardiology, City Clinic Hospital, Sofia, Bulgaria

^d Clinic of Diagnostic Imaging, Tokuda Hospital, Sofia, Bulgaria

The circle of Willis (CoW) forms the main circulatory system in the human brain. A large number of variations of the CoW is known, and also their association with ischemic stroke.
Three cases of young patients with combination of ischemic stroke and anomalies in the CoW are presented, and the value of the color-coded duplex sonography (CCDS) is compared to other imaging diagnostics such as magnetic resonance angiography (MRA) and digital subtraction angiography (DSA).
In these patients we found multiple risk factors such as: stenosis or thrombosis of intracranial brain vessels, mechanical compression of vessels, a genetic mutation associated with an increased risk of thrombosis, intake of oral contraceptives. For clinical evaluation several methods were used: detailed medical history, neurological status, laboratory examinations (complete blood count, biochemistry, lipid profile, HIV1/2, Syphilis RPR test), screening for markers associated with an increased risk of thrombosis, chest X-ray, spinal fluid study, CCDS, DSA, MRA. A full conformity in the data from CCDS and other imaging methods was found.
The authors discuss the pathogenetic role of congenital anomalies of CoW, incidence of ischemic stroke and the high diagnostic value of CCDS for finding such anomalies.

Keywords: Color-coded duplex sonography; Congenital abnormalities of the circle of Willis; Ischemic stroke; Magnetic resonance angiography

Received: August 26, 2015; Revised: November 22, 2015; Accepted: November 23, 2015; Published: December 1, 2016  Show citation