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HUMAN BIOLOGY Nervous system

What is the circle of

Willis?
Medically reviewed by Seunggu Han, M.D. — By Jon
Johnson on May 14, 2020

What it is Function Structural differences

Associated conditions Summary

The circle of Willis is a junction of

several important arteries at the
bottom part of the brain. It helps
blood flow from both the front and
back sections of the brain.

The circle of Willis gets its name from the

physician Thomas Willis, who described 
this part of the anatomy in 1664.

It may play a passive role in protecting a

person from some health issues, such as
stroke. However, it has an association with
intracranial aneurysms. Keep reading to
learn more about the circle of Willis,
including its function and associated
diseases.
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What is it?

The circle of Willis is an important junction of

arteries at the base of the brain. The
structure encircles the middle area of the
brain, including the stalk of the pituitary
gland and other important structures.

Two arteries, called the carotid arteries,

supply blood to the brain. They run along
either side of the neck and lead directly to
the circle of Willis.

Each carotid artery branches into an internal

and external carotid artery. The internal
carotid artery then branches into the
cerebral arteries. This structure allows all of
the blood from the two internal carotid
arteries to pass through the circle of Willis.

The structure of the circle of Willis includes:

left and right internal carotid arteries

left and right anterior cerebral arteries

left and right posterior cerebral arteries

left and right posterior communicating

arteries

basilar artery

anterior communicating artery

The circle of Willis is critical, as it is the

meeting point of many important arteries
supplying blood to the brain. The internal
carotid arteries branch off from here into
smaller arteries, which deliver much of the
brain’s blood supply.

Function
The circle of Willis plays an important role, as
it allows for proper blood flow from the
arteries to both the front and back
hemispheres of the brain. The arteries that
stem off from the circle of Willis supply much
of the blood to the brain.

The circle of Willis also serves as a sort of

safety mechanism when it comes to blood
flow. If a blockage or narrowing slows or
prevents the blood flow in a connected
artery, the change in pressure can cause
blood to flow forward or backward in the
circle of Willis to compensate.

This mechanism could also help blood flow

from one side of the brain to the other in a
situation in which the arteries on one side
have reduced blood flow. In an emergency,
such as a stroke, this may reduce the
damage or aftereffects of the event.

Importantly, the circle of Willis does not

actively carry out the function. Instead, the
natural shape of the circle and the way that
pressure acts in the area simply allow for
bidirectional blood flow when necessary.
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Structural differences
Structural differences in the circle of Willis
are common. The classic, complete anatomy
of a circle of Willis is, in fact, only apparent in
a minority of cases.

It is more common to see one of a few

variations in the structure of the circle of
Willis. A study in PLOS ONE  notes that
about 70% of people may have an
incomplete circle of Willis.

An incomplete circle of Willis can take a few

different forms. A smaller study in the
Journal of Morphological Sciences found
that at least one variation was present in the
circle of Willis in 54% of cases. The most
common structural difference was the
absence of a posterior communicating artery
connecting to the circle of Willis.

Other variations are also common. For

instance, a change in the anterior
communicating artery may keep the circle of
Willis from being complete. A few different
changes are possible here, including
fenestration and duplication.

Fenestration occurs when a single vessel

divides into two channels and then becomes
one channel again later.

Duplication means that there are two distinct

arteries where there is usually one.

In rarer cases, people may have an azygos

anterior cerebral artery (ACA), which occurs
when the two ACA blood vessels fuse into
one.

Genetics may play a role here, and certain

forms of incomplete circle of Willis structures
may be more common among family
members.
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Associated conditions
Several diseases and conditions have an
association with the circle of Willis, including:

Stroke

The structure and function of the circle of

Willis may protect against stroke in people
who have a complete circle of Willis. The
complete circle allows blood to go from one
side of the brain to the other, even when
blockages or thinning vessels occur.

The change in pressure from a blockage or

thinning vessel could cause blood to flow
backward through the circle of Willis and still
reach similar areas of the brain or other
important structures. This process is called
collateral circulation, and it may protect a
person from major events or a lack of
oxygen in the brain due to impaired blood
flow.

However, collateral circulation is not a

guaranteed effect, and it may only occur in
people with a mostly or fully complete circle
of Willis.

Aneurysms

The circle of Willis is a very common place

for intracranial aneurysms to occur. An
estimated 85%  of all intracranial aneurysms
occur here.

Aneurysms refer to arteries that bulge or

balloon out. The major risk with aneurysms is
rupturing, which causes bleeding in the
brain. A ruptured aneurysm can cause an
extremely severe headache alongside other
symptoms, such as vision problems, light
sensitivity, and a stiff neck.

Learn more about brain aneurysms here.

Subclavian steal syndrome

Subclavian steal syndrome is a rare

condition that may go unnoticed, as it is
largely asymptomatic.

It occurs when there is not enough blood

supply to an arm through the subclavian
artery. When this happens, extra blood flows
through the circle of Willis to make up for the
lack of blood supply, but this may result in
insufficient blood going to the brain.

If symptoms do occur, they may appear due

to an ischemic event. Some possible
symptoms of subclavian steal syndrome
include:

a numb arm or arm pain

general fatigue

cold skin from lack of blood supply

dizziness when exercising

Summary
The circle of Willis is an important juncture in
the body. As the carotid arteries travel up to
the base of the brain, they branch into the
circle of Willis. From there, other smaller
arteries that stem off from the circle supply
much of the blood to the brain.

The circle of Willis may also play a passive

role in protecting against stroke in people
who have a complete circle of Willis.
However, a complete circle of Willis is less
common than other variants.

Many aneurysms also occur within the circle

of Willis, although the risk of rupture may be
less than it would be in smaller arteries.
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Last medically reviewed on May 14, 2020

Stroke Blood / Hematology

Neurology / Neuroscience

How we reviewed this article:

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What is the function

of the carotid arteries?
Medically reviewed by Deborah
Weatherspoon, Ph.D., MSN — By Jenna
Fletcher on March 10, 2020

Anatomy Function
Carotid artery disease Treatment
Summary

The function of the carotid arteries

is to help transport blood into a
person’s brain and other areas in
the head, making them essential to
brain function.

Arteries play a vital role in transporting

oxygen-rich blood from the heart to other
parts of the body.

Keep reading for more information about the

carotid arteries, including their anatomy and
function. We also discuss the role that they
play in carotid artery disease.
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Anatomy

The carotid arteries extend out from the

aorta artery, which transports blood out of
the heart and is the body’s largest artery.

The carotid arteries carry blood through the

neck up to the brain. There are two carotid
arteries: one on the left and one on the right.

In the neck, each of them branches off into

an internal carotid artery and an external
carotid artery.

The position of the branched carotid arteries

is where a person can feel the pulse in their
neck, just under the jaw.

There are an additional eight major divisions


of the carotid arteries. The different
divisions help transport blood to different
parts of the head and face.

Function
The carotid arteries transport oxygen-rich
blood from the heart to the brain and head.
Some of the areas that carotid arteries help
supply with blood include the:

brain

face

scalp
roof of the mouth

tongue

seventh cranial nerve

oral cavity

teeth

ears

supporting muscles in the face and

neck

Without adequate blood flow and oxygen,

brain cells will die off, resulting in brain
damage.
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Carotid artery disease

Carotid artery disease is a condition in which
the carotid arteries narrow. This narrowing
reduces the amount of oxygen-rich blood
that can flow through these vessels.

The most common cause of carotid artery

disease is atherosclerosis, which is a buildup
of plaques comprising fatty deposits,
cholesterol, and other substances.

Several factors put a person at increased risk

of developing carotid artery disease. These
include:

diabetes

being male

having an elevated level of fats in the

blood

obesity

reaching an older age

a diet high in saturated fats

family history

genetic factors

a sedentary lifestyle

smoking

high blood pressure

A person may not experience any symptoms

of carotid artery disease. If the arteries get
so narrow that a blockage forms, however,
they could experience a transient ischemic
attack (TIA) or stroke.

A TIA is similar to a stroke in that it causes a

lack of blood flow to parts of the brain for a
short time.

However, unlike a stroke, the symptoms of

TIA are temporary and will typically go away.

If a person experiences either a TIA or a

stroke, they may show signs such as:

lack of coordination or inability to move

blurred vision

a sudden weakness, numbness, or

paralysis on one side of the body

temporary vision loss

dizziness or fainting

confusion

inability to concentrate

slurred or incoherent speech

a headache

A stroke is a medical emergency. Anyone

who witnesses someone possibly having a
stroke should call 911 or the local emergency
number immediately.

A doctor may use several different tests to

determine whether a person has carotid
artery disease or has had a stroke or TIA.
These tests include:

MRI scan

carotid artery duplex scan

auscultation (listening to the internal

sounds of the body using a
stethoscope) of the carotid arteries

CT scan

angiography

magnetic resonance angiography

Once a doctor has diagnosed carotid artery

disease, they will recommend treatment
options to help prevent future complications.
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Treatment
There are several treatment options for
carotid artery disease.

If the carotid artery narrowing is less than

50%, a doctor will often treat the blockage
with medications and lifestyle changes.

They may recommend the following

medications:

antihypertensives, which lower blood

pressure

antihyperlipidemics, which lower blood

lipid levels

antiplatelet medications

Possible lifestyle changes may include:

quitting smoking

exercising regularly

eating a more healthful and balanced

diet

If a person has a more severe blockage, a

doctor may recommend additional
treatments, such as carotid angioplasty with
stenting (CAS). CAS is a minimally invasive
procedure.

During a CAS procedure, a doctor inserts a

small hollow tube, or catheter, into the
arteries through the person’s groin. The
catheter may have a balloon at its tip, which
the doctor can use to increase the size of the
artery so that they can place a stent in the
artery.

The stent helps hold the artery open,

reducing the risk of blockages.

In some cases, a doctor may recommend a

carotid endarterectomy (CEA). A CEA is a
procedure in which the doctor cleans plaque
from the carotid artery.

A person’s treatment will vary depending on

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their age, overall health, and medical history,
as well as how advanced the carotid artery