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Abstract
Background and purposeBilateral carotid artery occlusion (CAO) is a rare condition and the collateral circulation is more complicated than in unilateral CAO. The circle of Willis (CoW) is the most important collateral circulation compensation pathway in CAO. However, the specific role of CoW in the collateral circulation compensation pathway of CAO has not been fully elucidated. The purpose of this study is to investigate the role of CoW in the collateral circulation compensation pathway of CAO.Materials and methodsClinical, imaging, and hemodynamic data of 30 patients with bilateral CAO were collected to analyze the collateral blood flow compensation pathway and its characteristics, and to examine the correlation between the structure of the CoW and the collateral circulation of bilateral CAO.ResultsThis paper summarized 30 patients with bilateral CAO. There were 0 cases of the CoW complete type, 18 cases of the partially complete type (60%), and 12 cases of the incomplete type (40%). For the partially complete type cases, there were 14 complete anterior circulation cases (46.7%). The collateral circulation collateral circulation pathway included 14 cases with anterior communicating artery(ACoA), 7 cases with posterior cerebral artery (PCA)-middle cerebral artery (MCA) leptomeningeal anastomosis (LMA), 5 cases with ophthalmic artery(OA), 3 cases with lateral posterior communicating artery(PCoA), 1 case with internal carotid artery (ICA) stealing, 1 case with new Moyamoya vessels, and 4 cases of other types. There were four cases (13.3%) with complete posterior circulation, including four cases with bilateral PCoA, three cases with PCA-MCA LMA, and two cases with OA. There were 12 cases (40%) with incomplete CoW, including 8 cases with PCA-MCA LMA, 3 cases with lateral PCoA, 1 case with anterior cerebral artery (ACA)-MCA LMA, 4 cases with OA, and 1 other case.ConclusionThe collateral circulation pathway differs among patients with different CoW structure types. When the CoW is partially complete, it mainly provides blood flow compensation to the ischemic area through primary collateral circulation. When the CoW is incomplete, it mainly provides blood flow compensation to the ischemic area through secondary collateral circulation.
Highlights
Carotid artery stenosis is an important cause of ischemic stroke, and the incidence of carotid artery stenosis in patients with ischemic stroke is 15–20% [1]
There were 12 cases (40%) of the circle of Willis (CoW) incomplete type, and the collateral circulation collateral circulation included 8 cases with posterior cerebral artery (PCA)-middle cerebral artery (MCA) leptomeningeal anastomosis (LMA), 3 cases with lateral posterior communicating artery (PCoA), 1 case with anterior cerebral artery (ACA)-MCA LMA, 4 cases with ophthalmic artery (OA), and 1 other case (Table 1, Fig.3)
It can be seen that bilateral carotid artery occlusion (CAO) is rare in patients, but once the lesion occurs, the bilateral anterior circulation of cerebral artery will be in an ischemia state, which is prone to serious ischemic stroke events
Summary
Carotid artery stenosis is an important cause of ischemic stroke, and the incidence of carotid artery stenosis in patients with ischemic stroke is 15–20% [1]. The CoW is the most important collateral circulation compensation pathway in the cranium. It connects the left and right hemispheres of the brain with anterior and posterior circulation. Compared with unilateral carotid stenosis, bilateral carotid stenosis has a lower incidence and collateral compensation is more complex [4], so there are few studies at present. The circle of Willis (CoW) is the most important collateral circulation compensation pathway in CAO. The specific role of CoW in the collateral circulation compensation pathway of CAO has not been fully elucidated. The purpose of this study is to investigate the role of CoW in the collateral circulation compensation pathway of CAO. Materials and methods Clinical, imaging, and hemodynamic data of 30 patients with bilateral CAO were collected to analyze the collateral blood flow compensation pathway and its characteristics, and to examine the correlation between the structure of the CoW and the collateral circulation of bilateral CAO
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