Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Department of Stroke and Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
J Neurointerv Surg. 2024 Jul 16;16(8):801-808. doi: 10.1136/jnis-2023-020326.
Collateral circulation is an important determinant of outcome in people with acute ischemic stroke due to large vessel occlusion (LVO).
To explore the impact of the circle of Willis (CW) anatomical characteristics ipsilateral to the occlusion site, particularly the posterior communicating artery (PComA) and the A1-portion of the anterior cerebral artery (A1-ACA), on stroke outcomes in a cohort of patients with LVO and middle cerebral artery (MCA) occlusion, undergoing endovascular thrombectomy (EVT).
This is a retrospective cohort study performed in a comprehensive tertiary stroke center. The study population consisted of consecutive patients with LVO with proximal MCA occlusion (M1) between June 2016 and April 2021, undergoing EVT. Demographic, clinical, and imaging information was extracted from patient files. Patency and diameters of ipsilateral A1-ACA and PComA were manually measured on admission CT angiography images in the core laboratory.
One hundred and five patients with LVO comprised the study cohort, mean age 72.3 years, 43.8% were male, mean National Institutes of Health Stroke Scale score at admission 15.2. The cohort was grouped according to CW vessel characteristics. On univariate analysis, a well-developed PComA was associated with lower rates of hemorrhagic transformation (1.8% vs 14.3%, P=0.01) and a trend towards lower mortality rates (8.9% vs 20.4%, P=0.08).On multivariable regression analysis a well-developed PComA emerged as an independent predictor for survival (aOR=0.09, 95% CI 0.01 to 0.4 for survival at discharge, P=0.009, aOR=0.22, 95% CI 0.05 to 0.8 for survival at 90 days, P=0.02).
In a cohort of patients with LVO due to M1 occlusion undergoing EVT, a well-developed PComA was associated with significantly lower hemorrhagic transformation rates, a trend towards better functional outcomes, and independently predicted survival. Larger studies are needed to understand the differential effect of CW collateral conduits on stroke outcome and evaluate the practicality of incorporating such factors in the clinical decision-making process prior to EVT.
侧支循环是大血管闭塞（LVO）导致急性缺血性脑卒中患者结局的重要决定因素。
探讨闭塞部位同侧Willis 环（CW）解剖特征，特别是后交通动脉（PComA）和大脑前动脉 A1 段（A1-ACA），对接受血管内血栓切除术（EVT）的 LVO 和大脑中动脉（MCA）闭塞患者的卒中结局的影响。
这是一项在综合性三级卒中中心进行的回顾性队列研究。研究人群包括 2016 年 6 月至 2021 年 4 月期间接受 EVT 的 LVO 伴近端 MCA 闭塞（M1）的连续患者。从患者病历中提取人口统计学、临床和影像学信息。在核心实验室的入院 CT 血管造影图像上手动测量同侧 A1-ACA 和 PComA 的通畅性和直径。
105 例 LVO 患者组成了研究队列，平均年龄 72.3 岁，43.8%为男性，入院时平均国立卫生研究院卒中量表评分 15.2 分。该队列根据 CW 血管特征进行分组。单因素分析显示，PComA 发育良好与较低的出血转化率（1.8%比 14.3%，P=0.01）和死亡率降低趋势（8.9%比 20.4%，P=0.08）相关。多变量回归分析显示，PComA 发育良好是出院时存活的独立预测因素（优势比 0.09，95%可信区间 0.01 至 0.4，P=0.009，优势比 0.22，95%可信区间 0.05 至 0.8，P=0.02）。
在接受 EVT 的 M1 闭塞 LVO 患者队列中，PComA 发育良好与较低的出血转化率、更好的功能结局趋势显著相关，并独立预测存活。需要更大的研究来了解 CW 侧支通路对卒中结局的不同影响，并评估在 EVT 之前将此类因素纳入临床决策过程的实用性。
