Abstract
The relationship between the severity of intracranial atherosclerotic disease and the circle of Willis integrity is unclear. In this brief report, we investigate the associations between symptomatic intracranial atherosclerotic disease and the integrity of the circle of Willis. Patients with symptomatic intracranial atherosclerosis were enrolled and underwent intracranial artery magnetic resonance vessel wall imaging and time-of-flight angiography. The presence or absence of an intracranial atherosclerotic plaque and its maximum wall thickness and stenosis were evaluated. The presence or absence of the A1 segment of the bilateral anterior cerebral arteries (from the internal carotid artery to the anterior communicating artery segment is called anterior cerebral artery A1 segment), and anterior communicating artery, the P1 segment of the bilateral posterior cerebral arteries (The P1 segment of the posterior cerebral artery is a horizontally outward segment), and bilateral posterior communicating arteries were determined. The associations of the intracranial plaque features with the integrity of the circle of Willis were analyzed. Of the 110 recruited subjects (57.2 ± 11.1 years; 65% males), 51 had intracranial plaques, and 44 had stenosis. In patients with bilateral A1 and P1 segments (n = 85), intracranial stenosis was more severe in patients with an anterior communicating artery than those without an anterior communicating artery (19.7% ± 21.7% vs. 1.4% ± 3.3%, p = 0.046). In patients with bilateral A1 and P1 segments and an anterior communicating artery (n = 79), intracranial stenosis was more severe in patients with posterior communicating arteries than those without posterior communicating arteries (27.9% ± 23.7% vs. 13.5% ± 17.9%, p = 0.007). The odds ratio of intracranial stenosis was 1.214 (95% confidence interval (CI), 1.054-1.398; p = 0.007) in discriminating for the presence of posterior communicating arteries in patients with bilateral A1 and P1 segments and an anterior communicating artery after adjusting for confounding factors. The severity of intracranial atherosclerosis was independently associated with the presence of posterior communicating arteries in patients with a complete anterior part of the circle of Willis.
Highlights
Intracranial atherosclerosis is the main cause of ischemic stroke in an Asian population, divided into symptomatic and asymptomatic types
Symptomatic intracranial atherosclerosis refers to ischemic stroke or transient ischemic attack occurring in the stenosis area of the supplying artery [1]
This study investigates the associations between the severity of intracranial atherosclerotic disease and the integrity of communicating arteries in the circle of Willis (COW) using three-dimensional (3D) magnetic resonance (MR) vessel wall imaging
Summary
Intracranial atherosclerosis is the main cause of ischemic stroke in an Asian population, divided into symptomatic and asymptomatic types. Symptomatic intracranial atherosclerosis refers to ischemic stroke or transient ischemic attack occurring in the stenosis area of the supplying artery [1]. It is well established that the progression of the intracranial atherosclerotic disease will decrease blood perfusion and increase the risk of cerebral ischemic events [2,3,4,5,6]. During the progression of atherosclerotic cerebrovascular disease, the compensatory system can be initiated through the collateral circulation to preserve perfusion and stabilize cerebral blood flow [7,8,9,10,11]. Since atherosclerosis is a systemic disease that frequently involves multiple vascular beds (including the contralateral carotid artery and basilar artery), knowledge of the dominant communicating arteries is important for developing treatment strategies in patients diagnosed with atherosclerotic diseases multiple vascular beds
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