PCOMAPolycystic Ovaries and Menstrual Abnormalities
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categorised the various configuration of COW in foetus.17 There is a transitional type in early foetal life, in which diameters of P1 segment of PCA and PComA are equal; with the growth of the foetus this would either transform into adult type in which P1 diameter is larger than the PComA diameter or into foetal type in which diameter of the P1 is smaller than diameter of PcomA.12 Van Overbeeke et al.
Foetal type posterior communicating artery (FTPcomA) was considered when the posterior cerebral artery (PCA) originated from the ipsilateral internal carotid artery (ICA) instead of the basilar artery with diameter greater than the ipsilateral pre-communicating segment (P1) of the PCA.12 Vessel arising from ICA with equal or smaller diameter than the ipsilateral P1 of the PCA were classified as PcomAs.12 COW was then classified as complete, partially complete and incomplete configuration.
Most of the ruptured aneurysms detected by DSA are located in the AComA, PComA, and MCA.
Most patients with this anomaly are asymptomatic, and it is identified only incidentally due to sufficient cerebral collateral circulation, commonly through the bilateral PCOMAs. Symptomatic patients often present with ischemic or hemorrhagic stroke.