Sablić Sara, Dolić Krešimir, Kraljević Ivan, Budimir Mršić Danijela, Čičmir-Vestić Mate, Benzon Benjamin, Lovrić Kojundžić Sanja, Marinović Guić Maja
Clinical Department of Diagnostic and Interventional Radiology, University Hospital of Split, 21000 Split, Croatia.
University of Split School of Medicine, 21000 Split, Croatia.
Biomedicines. 2023 Nov 9;11(11):3008. doi: 10.3390/biomedicines11113008.
Acute ischemic stroke (AIS) is the world's second leading cause of mortality. An established method for treating stroke patients in acute settings is endovascular therapy (EVT). However, the correlation of the successful endovascular treatment of AIS with the presence of communicating arteries in the circle of Willis needs to be proven. Our study examined clinical and radiological data of 158 consecutive patients treated with mechanical thrombectomy (MT) at our comprehensive stroke center. We analyzed their CT angiograms and digital subtraction angiography (DSA) to assess anatomical variants of Willis' circle and formed two groups-collateral-negative and collateral-positive group. The first group included patients with aplasia of both anterior (ACoA) and posterior communicating Artery (PCoA). The second group included patients that have at least one communicating artery (either anterior or posterior). We evaluated their reperfusion outcomes and functional recovery three months later. Our results showed that patients with communicating arteries had smaller areas of infarction on post-interventional CT and higher rates of functional recovery (Modified Rankin Score). The ACoA had a higher impact on early and late outcomes, confirmed by lower control CT scores and more favorable functional recovery. Therefore, anatomic variants of Willis' circle should be considered as a significant prognostic factor in AIS.
急性缺血性卒中(AIS)是全球第二大致死原因。在急性情况下治疗卒中患者的一种既定方法是血管内治疗(EVT)。然而,AIS血管内治疗成功与否与 Willis 环交通动脉的存在之间的相关性尚需证实。我们的研究检查了在我们的综合卒中中心接受机械取栓术(MT)治疗的 158 例连续患者的临床和放射学数据。我们分析了他们的 CT 血管造影和数字减影血管造影(DSA),以评估 Willis 环的解剖变异,并形成两组——侧支循环阴性组和侧支循环阳性组。第一组包括前交通动脉(ACoA)和后交通动脉(PCoA)均发育不全的患者。第二组包括至少有一条交通动脉(前交通动脉或后交通动脉)的患者。我们在三个月后评估了他们的再灌注结果和功能恢复情况。我们的结果表明,有交通动脉的患者在介入后 CT 上梗死面积较小,功能恢复率较高(改良 Rankin 量表评分)。ACoA 对早期和晚期结果的影响更大,较低的对照 CT 评分和更有利的功能恢复证实了这一点。因此,Willis 环的解剖变异应被视为 AIS 的一个重要预后因素。