UOSD Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, 98125, Messina, Italy.
Neuroradiology Unit, Biomedical Sciences and of Morphologic and Functional Images, University of Messina, Messina, Italy.
J Neurol. 2021 Oct;268(10):3799-3807. doi: 10.1007/s00415-021-10454-4. Epub 2021 Mar 30.
We aim to provide prevalence and pattern of anatomical variants of circle of Willis in over one thousand ischemic stroke patients compared to an age- and sex-matched control group, and to determine their role in the severity and in-hospital prognosis.
Two groups of neuroradiologists evaluated all vascular images of ischemic stroke patients and controls to identify anatomical variants using a preexisted classification. We collected data concerning patient characteristics, stroke severity on admission and discharge, in-hospital mortality, hemorrhagic transformation, acute treatment performed, and etiology.
We included 1131 patients with acute ischemic stroke and 562 controls. Among stroke patients, 702 (62.1%) had one or more vascular variants, compared to 308 (54.8%) of the control group (p < 0.01), 165/702 (23.5%) had an anterior circulation variant only, 384/702 (54.7%) had a posterior circulation variant only, and 153/702 (21.8%) patients had variants in both anterior and posterior circulation. Patients with variants were older (69.7 ± 13.9 years vs 72.0 ± 12.9 years; p = 0.039). The most prevalent variant was the agenesis/hypoplasia of the ACA (201/1131; 17.8%) followed by the unilateral fetal type of the PCA (137/1131; 12.11%).
We provided the prevalence and the pattern of the brain vascular variants of the circle of Willis in a cohort of patients with ischemic stroke. The prevalence of variants was higher in stroke patients compared to controls. Patients with variants were older but had no differences in sex, neurological admission severity, hemorrhagic transformation, etiology, and in-hospital outcome compared to patients with a typical circle of Willis.
我们旨在比较一千多名缺血性脑卒中患者与年龄和性别匹配的对照组，研究大脑前循环和后循环的血管解剖变异的患病率和模式，并确定其在严重程度和住院预后中的作用。
两组神经放射科医生使用预先存在的分类方法评估所有缺血性脑卒中患者和对照组的血管图像，以识别解剖变异。我们收集了有关患者特征、入院和出院时的卒中严重程度、住院死亡率、出血性转化、急性治疗和病因的数据。
我们纳入了 1131 名急性缺血性脑卒中患者和 562 名对照组。在脑卒中患者中，702 名（62.1%）存在一种或多种血管变异，而对照组中只有 308 名（54.8%）存在血管变异（p<0.01）。702 名患者中，165 名（23.5%）仅存在前循环变异，384 名（54.7%）仅存在后循环变异，153 名（21.8%）患者同时存在前循环和后循环变异。存在血管变异的患者年龄较大（69.7±13.9 岁 vs 72.0±12.9 岁；p=0.039）。最常见的变异是大脑前动脉（ACA）发育不全/发育不良（201/1131；17.8%），其次是单侧胎儿型大脑后动脉（PCA）（137/1131；12.11%）。
我们提供了缺血性脑卒中患者大脑血管环变异的患病率和模式。与对照组相比，脑卒中患者的变异患病率更高。存在血管变异的患者年龄较大，但与典型血管环的患者相比，在性别、入院时的神经严重程度、出血性转化、病因和住院预后方面无差异。
