Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.
Department of Neurology, Universitätsklinikum Essen, Essen, Germany.
Int J Stroke. 2022 Aug;17(7):770-776. doi: 10.1177/17474930211048381. Epub 2021 Oct 5.
Variants of the Circle of Willis (vCoW) may impede correct identification of ischemic lesion patterns and stroke etiology. We assessed reclassifications of ischemic lesion patterns due to vCoW.
We analyzed vCoW in patients with acute ischemic stroke from the 1000+ study using time-of-flight magnetic resonance angiography (TOF MRA) of intracranial arteries. We assessed A1 segment agenesis or hypoplasia in the anterior circulation and fetal posterior cerebral artery in the posterior circulation. Stroke patterns were classified as one or more-than-one territory stroke pattern. We examined associations between vCoW and stroke patterns and the frequency of reclassifications of stroke patterns due to vCoW.
Of 1000 patients, 991 had evaluable magnetic resonance angiography. At least one vCoW was present in 37.1%. VCoW were more common in the posterior than in the anterior circulation (33.3% vs. 6.7%). Of 238 patients initially thought to have a more-than-one territory stroke pattern, 20 (8.4%) had to be reclassified to a one territory stroke pattern after considering vCoW. All these patients had fetal posterior cerebral artery and six (30%) additionally had carotid artery disease. Of 753 patients initially presumed to have a one-territory stroke pattern, four (0.5%) were reclassified as having more-than-one territory pattern.
VCoW are present in about one in three stroke patients and more common in the posterior circulation. Reclassifications of stroke lesion patterns due to vCoW occurred predominantly in the posterior circulation with fetal posterior cerebral artery mimicking multiple territory stroke pattern. Considering vCoW in these cases may uncover symptomatic carotid disease.
Willis 环（CoW）的变异可能会妨碍对缺血性病变模式和中风病因的正确识别。我们评估了 CoW 引起的缺血性病变模式的重新分类。
我们使用颅内动脉的时间飞跃磁共振血管造影（TOF MRA）分析了来自 1000+研究的急性缺血性中风患者的 CoW。我们评估了前循环中的 A1 段发育不全或发育不良以及后循环中的胎型大脑后动脉。中风模式被分类为一个或多个区域中风模式。我们研究了 CoW 与中风模式之间的关联以及 CoW 引起的中风模式重新分类的频率。
在 1000 名患者中，有 991 名患者可评估磁共振血管造影。37.1%的患者至少存在一种 CoW。后循环中的 CoW 比前循环更常见（33.3%比 6.7%）。在最初认为存在多个区域中风模式的 238 名患者中，有 20 名（8.4%）在考虑 CoW 后必须重新分类为一个区域中风模式。所有这些患者都有胎型大脑后动脉，其中 6 名（30%）患者还患有颈动脉疾病。在最初假定为一个区域中风模式的 753 名患者中，有 4 名（0.5%）被重新分类为多个区域模式。
CoW 约存在于三分之一的中风患者中，在后循环中更为常见。由于 CoW 导致的中风病变模式的重新分类主要发生在后循环中，胎型大脑后动脉模拟了多个区域的中风模式。在这些病例中考虑 CoW 可能会发现症状性颈动脉疾病。
