Kim Kang Min, Kang Hyun-Seung, Lee Woong Jae, Cho Young Dae, Kim Jeong Eun, Han Moon Hee
Department of Neurosurgery, Kangwon National University Hospital, Gangwon-do, Republic of Korea.
Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
J Neurointerv Surg. 2016 Mar;8(3):251-5. doi: 10.1136/neurintsurg-2014-011439. Epub 2014 Dec 9.
The effectiveness of a scoring system based on the circle of Willis for evaluations of collateral circulation was studied in patients with intracranial atherosclerotic stenosis.
Eighty-three patients who underwent medical or endovascular treatment for symptomatic and severe intracranial atherosclerotic stenosis were enrolled in the study. Clinical profiles, status of the circle of Willis (poor and good integrity group), and clinical outcomes were analyzed. Primary endpoints were: (1) symptomatic ischemic or hemorrhagic stroke within 30 days; and (2) recurrent transient ischemic attack or ischemic stroke beyond 30 days.
The estimated rates of the primary endpoint at 1 and 2 years after treatment were 8.5% and 11.4% in the medical group and 7.0% and 9.7% in the endovascular group, respectively. A primary endpoint event after medical treatment was only identified in patients with poor integrity of the circle of Willis (p=0.059). In patients with poor integrity of the circle of Willis, previous antiplatelet medication before initial presentation (p=0.026) and hypertension (p=0.006) were more prevalent. During the follow-up period, complete arterial occlusion was identified in 9 patients. The circle of Willis score of the patients with complete arterial occlusion was 1.33±1.52 in the fatal stroke group (n=3) and 3.20±1.64 in the asymptomatic group (n=6, p=0.099).
If patients have poor integrity of the circle of Willis, the risk of recurrent stroke may be increased. Such patients appear to be good candidates for endovascular treatment.
在颅内动脉粥样硬化狭窄患者中，研究了基于 Willis 环的评分系统对侧支循环评估的有效性。
83 例因症状性和重度颅内动脉粥样硬化狭窄接受药物或血管内治疗的患者纳入本研究。分析临床资料、Willis 环状态（完整性差和良好组）及临床结局。主要终点为：（1）30 天内发生症状性缺血性或出血性卒中；（2）30 天后复发性短暂性脑缺血发作或缺血性卒中。
治疗后 1 年和 2 年，药物治疗组主要终点的估计发生率分别为 8.5%和 11.4%，血管内治疗组分别为 7.0%和 9.7%。仅在 Willis 环完整性差的患者中发现药物治疗后发生主要终点事件（p=0.059）。在 Willis 环完整性差的患者中，初次就诊前曾使用抗血小板药物（p=0.026）和高血压（p=0.006）更为常见。随访期间，9 例患者出现完全动脉闭塞。致命性卒中组（n=3）完全动脉闭塞患者的 Willis 环评分为 1.33±1.52，无症状组（n=6）为 3.20±1.64（p=0.099）。
如果患者 Willis 环完整性差，复发性卒中风险可能增加。这类患者似乎是血管内治疗的良好候选者。
