Abstract:
Background: Circle of Willis is the main structure that provides constant and regular blood flow to the brain, protects
the brain from ischemia. Stroke has remained the second leading cause of death globally in the last fifteen years. It is
the fifth leading cause of death in the United States. It is also the leading cause of serious adult disability. Interlinked
problems related to ischemic stroke are become increasing nowadays. Strong evidence is needed about the pooled
measure of association between the circle of Willis (COW) and ischemic stroke. Therefore, this systematic review and
meta-analysis were intended to provide compressive and up to date evidence on the association between the variations of COW and ischemic stroke using the available studies.
Methods: PubMed, Google Scholar, Science Direct, and Cochrane Library databases were systematically searched.
All essential data were extracted using a standardized data extraction template. The heterogeneity across studies was
assessed by using the Cochrane Q test statistic, I2 test statistic, and P-values. A fixed-effect model was used to estimate
the pooled effect of the measure association between COW and ischemic stroke.
Results: In this meta-analysis, 2,718 participants were involved. The pooled measure of association between COW
and ischemic stroke was 1.38 (95% CI 0.87, 2.19). Therefore, this indicated that the presence of any variation in COW
was 1.38 times more likely to develop ischemic stroke as compared to the patent COW. The presence of hypoplasia/
incompleteness in a posterior communicating artery (PcomA) [Pooled OR: 1.34 (95% CI 0.80, 2.25)] and anterior communicating artery (AcomA) [Pooled OR: 1.32 (95% CI 0.81, 2.19)] were a contributing factor for the development of
ischemic stroke. Hypertension was the most common comorbid condition, followed by diabetes mellitus, smoking,
coronary artery disease, and hyperlipidemia.
Conclusions: There was a non-significant positive association between COW variation and ischemic stroke in this
meta-analysis.
Keywords: Circle of willis, Ischemic stroke, Association, Systematic review and meta-analysis
