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World Neurosurg. 2018 Jul;115:e585-e591. doi: 10.1016/j.wneu.2018.04.104. Epub 2018 Apr 24.

Clinical Significance of the Circle of Willis in Patients with Symptomatic Internal Carotid Artery Occlusion.

Author information

1
Department of Neurosurgery, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Gangwon-do, Republic of Korea.
2
Department of Neurosurgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea. Electronic address: quintus@snu.ac.kr.
3
Department of Radiology, Chung-ang University Hospital, Seoul, Republic of Korea.
4
Department of Nuclear Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Gangwon-do, Republic of Korea.
5
Department of Neurology, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Gangwon-do, Republic of Korea.

Abstract

BACKGROUND:

Despite improvements in medical treatment, many patients experience ischemic stroke owing to internal carotid artery occlusion. We retrospectively evaluated a novel method based on the arterial structure of the circle of Willis (CoW) to identify patients at a high risk of recurrent stroke.

METHODS:

The study enrolled 104 patients with symptomatic occlusion of the internal carotid artery. CoW integrity was evaluated by a quantitative scoring system based on conventional angiography. Patients were categorized into a good integrity (n = 45) or poor integrity (n = 59) group. Primary endpoint was early neurologic deterioration, recurrent ischemic stroke, or transient ischemic attack.

RESULTS:

History of ischemic stroke before initial presentation was more prevalent in the poor integrity group (22.2% vs. 47.5%, P = 0.01), and there were no differences between the 2 groups in terms of stroke risk factors. Overall estimated rate of the primary endpoint was 25.6% 2 years after angiography. It was 5.7% in the good integrity group and 39.8% in the poor integrity group (P < 0.001). In a Cox regression analysis, male sex (P = 0.01, hazard ratio = 6.60), use of a tissue plasminogen activator (P = 0.00, hazard ratio = 6.10), and poor integrity of CoW (P = 0.00, hazard ratio = 5.42) were risk factors for the primary endpoint. Patients in the poor integrity group with decreased vascular reserve experienced frequent primary endpoint events compared with patients in the good integrity group (P = 0.00).

CONCLUSIONS:

Patients with poor integrity of CoW are vulnerable to recurrent ischemic stroke and appear to require more aggressive treatment.

KEYWORDS:

Circle of Willis; Internal carotid artery; Occlusion; Stroke

PMID:
29702309
DOI:
10.1016/j.wneu.2018.04.104
[Indexed for MEDLINE]

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