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A ratio between certain arteries has been proposed to determine when an artery is smaller than expected. For example, the size of the PCOMM is one half of the size of the PCA, which itself is one half of the BA.14 The size of the ACOMM is also one half to BMS-354825 research buy two thirds of the ACA size, which itself is one half of the ICA. When the arteries are smaller than usual, they are considered to be hypoplastic or sling-like.43,44 In a large autopsy series of normal brains, CoW were classified as normal if they had all the typical arteries integrating in the CoW or deficient if lack of thereof. A ""normal"" CoW was found in only 52.3% and the remaining CoW had one or more anomalies.43 The most common anomaly was the presence of at least one hypoplastic artery with patent lumina (e.g., GSK1349572 artery was rarer (up to 2.0%) and it typically involved the ACOMM.43 In a population-based sample of community-dwellers without stroke, we also reported that a complete CoW was the exception.44 The majority of the subjects had at least one hypoplastic artery, which was typically the PCOMM and the posterior circulation was the most likely to have hypoplastic arteries. The difference in the rates noted between direct visualization in autopsy or DSA cases versus brain MRA can be partially attributed to lower accuracy of MRA techniques in distinguishing between a hypoplastic or absent artery.45 Specific arterial variants After reviewing the literature and synthesizing the data, we proposed a classification of cerebral variants into four groups: a) anomaly of a normally present artery, b) persistence of a normal embryonic artery, and c) visualization of normally hidden anastomoses. Arteries normally present in the adult CoW Internal carotid artery The normal ICA can be divided into multiple segments based on its course. The first segment (i.e., cervical) begins at the CCA bifurcation and ends at entrance into the skull base via the carotid foramen. SAR1B The second segment (i.e., ascending petrous) extends to the apex of the antero-medial curvature within petrous bone and ends with the origin of the carotico-tympanic artery. The third segment (i.e., horizontal petrous) ends at the skull base in the foramen lacerum. The fourth segment (i.e., ascending cavernous) enters the cavernous sinus and ends with the takeoff of the meningo-hypophyseal trunk where the ICA assumes an anterior-inferior course. The fifth segment (i.e., horizontal cavernous) extends from the meningo-hypophyseal trunk to the infero-lateral trunk within the cavernous sinus. The sixth segment (i.e., clinoidal) is bordered proximally by the infero-lateral trunk and distally by the adult OA. The seventh segment lies between the primitive OA and the ACA.24,46 An aberrant ICA pathway occurs when the ICA deviates from its anatomical landmarks.