Cargando…

Reclassifications of ischemic stroke patterns due to variants of the Circle of Willis

BACKGROUND: 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. METHODS: We analyzed vCoW in patients with acute ischemic stroke from the 1000+ study using ti...

Descripción completa

Detalles Bibliográficos
Autores principales: Rangus, Ida, Milles, Lennart S, Galinovic, Ivana, Villringer, Kersten, Audebert, Heinrich J, Fiebach, Jochen B, Nolte, Christian H, Hebun Erdur
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9358303/
https://www.ncbi.nlm.nih.gov/pubmed/34569879
http://dx.doi.org/10.1177/17474930211048381
_version_ 1784763901759455232
author Rangus, Ida
Milles, Lennart S
Galinovic, Ivana
Villringer, Kersten
Audebert, Heinrich J
Fiebach, Jochen B
Nolte, Christian H
Hebun Erdur,
author_facet Rangus, Ida
Milles, Lennart S
Galinovic, Ivana
Villringer, Kersten
Audebert, Heinrich J
Fiebach, Jochen B
Nolte, Christian H
Hebun Erdur,
author_sort Rangus, Ida
collection PubMed
description BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
format Online
Article
Text
id pubmed-9358303
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher SAGE Publications
record_format MEDLINE/PubMed
spelling pubmed-93583032022-08-10 Reclassifications of ischemic stroke patterns due to variants of the Circle of Willis Rangus, Ida Milles, Lennart S Galinovic, Ivana Villringer, Kersten Audebert, Heinrich J Fiebach, Jochen B Nolte, Christian H Hebun Erdur, Int J Stroke Research BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. SAGE Publications 2021-10-05 2022-08 /pmc/articles/PMC9358303/ /pubmed/34569879 http://dx.doi.org/10.1177/17474930211048381 Text en © 2021 World Stroke Organization https://creativecommons.org/licenses/by/4.0/This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Research
Rangus, Ida
Milles, Lennart S
Galinovic, Ivana
Villringer, Kersten
Audebert, Heinrich J
Fiebach, Jochen B
Nolte, Christian H
Hebun Erdur,
Reclassifications of ischemic stroke patterns due to variants of the Circle of Willis
title Reclassifications of ischemic stroke patterns due to variants of the Circle of Willis
title_full Reclassifications of ischemic stroke patterns due to variants of the Circle of Willis
title_fullStr Reclassifications of ischemic stroke patterns due to variants of the Circle of Willis
title_full_unstemmed Reclassifications of ischemic stroke patterns due to variants of the Circle of Willis
title_short Reclassifications of ischemic stroke patterns due to variants of the Circle of Willis
title_sort reclassifications of ischemic stroke patterns due to variants of the circle of willis
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9358303/
https://www.ncbi.nlm.nih.gov/pubmed/34569879
http://dx.doi.org/10.1177/17474930211048381
work_keys_str_mv AT rangusida reclassificationsofischemicstrokepatternsduetovariantsofthecircleofwillis
AT milleslennarts reclassificationsofischemicstrokepatternsduetovariantsofthecircleofwillis
AT galinovicivana reclassificationsofischemicstrokepatternsduetovariantsofthecircleofwillis
AT villringerkersten reclassificationsofischemicstrokepatternsduetovariantsofthecircleofwillis
AT audebertheinrichj reclassificationsofischemicstrokepatternsduetovariantsofthecircleofwillis
AT fiebachjochenb reclassificationsofischemicstrokepatternsduetovariantsofthecircleofwillis
AT noltechristianh reclassificationsofischemicstrokepatternsduetovariantsofthecircleofwillis
AT hebunerdur reclassificationsofischemicstrokepatternsduetovariantsofthecircleofwillis