Prevalence and Pattern of Cerebral Variations during Endovascular Diagnostic Angiography in Saudi Patients: A Retrospective Observational Study

Abstract

Background:  Previous studies detected large number of variations in circle of Willis in normal populations. There is limited data for the effect and correlation of normal varieties and pathologic vascular anomalies

Purpose:  Prevalence of normal variants and impact of its presence in decision making process.

Patients and methods: Ninety patients' records underwent therapeutic angiography were retrospectively reviewed and reallocated into two equal groups according to pathology (group 1=vascular malformation group, group 2= ischemic insults). Age, sex, type of pathology, site of normal variants and finally their impact on decision making process were calculated.   

Results: The mean and standard deviation of age in our study was found to be (40.18 years ± 15.6), most of patients were between 30-40 years old. The total number of normal variants that were detected in our study either at extra- or intracranial vascular tree was 46 variants. Forty-nine cases were "ignored" or added no impact on the proposed plan during neurointervention. The sensitivity of normal variants in changing decision making process was seen in 15% of cases while the specificity was 100%.

Conclusion:  Normal variants were detected accidently through DSA for therapeutic purposes in 47% of cases. The term normal vascular variation is simple to be defined per se. However, when additional vascular event (aneurysm or AVM) was detected, the neurointerventionist should be aware of its presence, possible complications and how to proceed to the target without additional damage. These variations should be reported and explained to the patient and/or family especially when they interfere with operative plan or decision to avoid medicolegal consequences.