Completeness of the circle of Willis and risk of ischemic stroke in patients without cerebrovascular disease.

Tom Van Seeters,L Jaap Kappelle,Willem Ptm Mali,Geert Jan Biessels,Yolanda Van Der Graaf,Birgitta K Velthuis,Jeroen Hendrikse

doi:10.1007/s00234-015-1589-2

Tom Van Seeters, L Jaap Kappelle + Show 5 more

Open Access

https://doi.org/10.1007/s00234-015-1589-2

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Journal: Neuroradiology	Publication Date: Sep 10, 2015
Citations: 65	License type: CC BY 4.0

Affiliation: University Medical Center Utrecht

Abstract

IntroductionWe investigated circle of Willis (CoW) completeness in relation to the risk of future ischemic stroke in patients without prior cerebrovascular disease.MethodsWe included 976 patients with atherosclerotic disease, but no previous TIA/stroke, from the Second Manifestations of ARTerial disease (SMART) study. All patients underwent MR angiography of the CoW. Cox regression was used to determine whether anterior CoW completeness (anterior communicating artery or A1 segments) and posterior CoW completeness (posterior communicating arteries or P1 segments) were related to future stroke, and whether CoW completeness influenced the relation between internal carotid artery (ICA) stenosis/occlusion and future stroke.ResultsThirty patients (3.1 %) had ischemic stroke after 9.2 ± 3.0 years of follow-up. Twenty-four patients (80 %) had anterior circulation stroke. An incomplete anterior CoW was related to future anterior circulation stroke (HR 2.8 (95 % CI 1.3–6.3); p = 0.01), whereas a one-sided and two-sided incomplete posterior CoW were not (HR 2.2 (95 % CI 0.7–7.1; p = 0.19) and 1.9 (95 % CI 0.6–5.9; p = 0.29), respectively). In stratified analyses, patients with an incomplete anterior CoW had the highest risk of future anterior circulation stroke when they also had a one-sided (HR 7.0 (95 % CI 1.3–38.2; p = 0.02)) or two-sided incomplete posterior CoW (HR 5.4 (95 % CI 1.0–27.8; p = 0.04). CoW completeness did not change the relation between asymptomatic ICA stenosis/occlusion and future ischemic stroke (p = 0.68).ConclusionsAn incomplete anterior CoW combined with an incomplete posterior CoW is related to future anterior circulation stroke. CoW completeness has no large effect on the relation between asymptomatic ICA stenosis/occlusion and future stroke.

Highlights

Introduction We investigated circle ofWillis (CoW) completeness in relation to the risk of future ischemic stroke in patients without prior cerebrovascular disease
Ischemic stroke occurred in 11/223 patients (4.9 %) with an incomplete anterior circle of Willis (CoW) and in 19/753 patients (2.5 %) with a complete anterior CoW
Regarding posterior CoW completeness, 13/398 patients (3.3 %) with a two-sided incomplete posterior CoW, 10/291 patients (3.4 %) with a one-sided incomplete posterior CoW, and 7/287 patients (2.4 %) with a complete posterior CoW suffered from ischemic stroke

Summary

Introduction

Willis (CoW) completeness in relation to the risk of future ischemic stroke in patients without prior cerebrovascular disease. Previous research suggests a relation between CoW completeness and risk of future ischemic stroke for patients with symptomatic cerebrovascular disease [3,4,5]. In these patients, patent CoW collaterals are thought to protect against future ischemic stroke by providing increased collateral flow. Patent CoW collaterals are thought to protect against future ischemic stroke by providing increased collateral flow This has only been investigated in patients with a severe stenosis or occlusion of the internal carotid artery (ICA). Asymptomatic patients with an ICA stenosis/occlusion could possibly remain asymptomatic because of patent CoW collaterals

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