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Circle of Willis variants and their association with outcome in patients with middle cerebral artery‐M1‐occlusion stroke
Author(s) -
Westphal Laura P.,
Lohaus Niklas,
Winklhofer Sebastian,
Manzolini Christian,
Held Ulrike,
Steigmiller Klaus,
Hamann Janne M.,
El Amki Mohamad,
Dobrocky Tomas,
Panos Leonidas D.,
Kaesmacher Johannes,
Fischer Urs,
Heldner Mirjam R.,
Luft Andreas R.,
Gralla Jan,
Arnold Marcel,
Wiest Roland,
Wegener Susanne
Publication year - 2021
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.15013
Subject(s) - medicine , modified rankin scale , stroke (engine) , middle cerebral artery , atrial fibrillation , collateral circulation , cardiology , circle of willis , occlusion , magnetic resonance angiography , confounding , posterior cerebral artery , cohort , magnetic resonance imaging , ischemic stroke , radiology , ischemia , mechanical engineering , engineering
Background An incomplete circle of Willis (CoW) has been associated with a higher risk of stroke and might affect collateral flow in large vessel occlusion (LVO) stroke. We aimed to investigate the distribution of CoW variants in a LVO stroke and transient ischemic attack (TIA) cohort and analyze their impact on 3‐month functional outcome. Methods CoW anatomy was assessed with time‐of‐flight magnetic resonance angiography (TOF‐MRA) in 193 stroke patients with acute middle cerebral artery (MCA)‐M1‐occlusion receiving endovascular treatment (EVT) and 73 TIA patients without LVO. The main CoW variants were categorized into four vascular models of presumed collateral flow via the CoW. Results 82.4% ( n = 159) of stroke and 72.6% ( n = 53) of TIA patients had an incomplete CoW. Most variants affected the posterior circulation (stroke: 77.2%, n = 149; TIA: 58.9%, n = 43; p = 0.004). Initial stroke severity defined by the National Institutes of Health Stroke Scale (NIHSS) on admission was similar for patients with and without CoW variants. CoW integrity did not differ between groups with favorable (modified Rankin Scale [mRS]): 0–2) and unfavorable (mRS: 3–6) 3‐month outcome. However, we found trends towards a higher mortality in patients with any type of CoW variant ( p = 0.08) and a higher frequency of incomplete CoW among patients dying within 3 months after stroke onset ( p = 0.119). In a logistic regression analysis adjusted for the potential confounders age, sex and atrial fibrillation, neither the vascular models nor anterior or posterior variants were independently associated with outcome. Conclusion Our data provide no evidence for an association of CoW variants with clinical outcome in LVO stroke patients receiving EVT.