Variants of the circle of Willis in ischemic stroke patients
Variants of the circle of Willis in ischemic stroke patients
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DOI：
10.1007/s00415-021-10454-4
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发表时间：
2021-03-30
影响因子：
6
通讯作者：
La Spina, Paolino
中科院分区：
文献类型：
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作者：
De Caro, Jolanda;Ciacciarelli, Antonio;La Spina, Paolino
目的提供1000多例缺血性卒中患者与年龄、性别匹配的对照组的Willis环解剖变异的发生率和模式，并确定其在病情严重程度和住院预后中的作用。方法两组神经放射科医生对缺血性中风患者和对照组的所有血管图像进行评估，以确定解剖学上的变异。我们收集了关于患者特征、入院和出院时的中风严重程度、住院死亡率、出血转化、所进行的急性治疗和病因学的数据。结果纳入急性缺血性卒中患者1131例，对照组562例。在卒中患者中，702例(62.1%)有一种或多种血管变异，而对照组有308例(54.8%)，165/702(23.5%)只有前循环变异，384/702(54.7%)只有后循环变异，153/702(21.8%)患者前循环和后循环都有变异。携带变异基因的患者年龄较大(69.7+/-13.9岁vs72.0+/-12.9岁；p=0.039)。最常见的变异是ACA发育不全/发育不全(201/1131，17.8%)，其次是单侧胎儿型Pca(137/1131，12.11%)。结论我们提供了一组缺血性卒中患者的Willis环脑血管变异的发生率和模式。与对照组相比，中风患者的变异体患病率更高。变异的患者年龄较大，但与典型的Willis环患者相比，在性别、神经入院严重程度、出血转化、病因和住院结果方面没有差异。
Purpose We aim to provide prevalence and pattern of anatomical variants of circle of Willis in over one thousand ischemic stroke patients compared to an age- and sex-matched control group, and to determine their role in the severity and in-hospital prognosis. Methods Two groups of neuroradiologists evaluated all vascular images of ischemic stroke patients and controls to identify anatomical variants using a preexisted classification. We collected data concerning patient characteristics, stroke severity on admission and discharge, in-hospital mortality, hemorrhagic transformation, acute treatment performed, and etiology. Results We included 1131 patients with acute ischemic stroke and 562 controls. Among stroke patients, 702 (62.1%) had one or more vascular variants, compared to 308 (54.8%) of the control group (p < 0.01), 165/702 (23.5%) had an anterior circulation variant only, 384/702 (54.7%) had a posterior circulation variant only, and 153/702 (21.8%) patients had variants in both anterior and posterior circulation. Patients with variants were older (69.7 +/- 13.9 years vs 72.0 +/- 12.9 years; p = 0.039). The most prevalent variant was the agenesis/hypoplasia of the ACA (201/1131; 17.8%) followed by the unilateral fetal type of the PCA (137/1131; 12.11%). Conclusions We provided the prevalence and the pattern of the brain vascular variants of the circle of Willis in a cohort of patients with ischemic stroke. The prevalence of variants was higher in stroke patients compared to controls. Patients with variants were older but had no differences in sex, neurological admission severity, hemorrhagic transformation, etiology, and in-hospital outcome compared to patients with a typical circle of Willis.