Logo image
Back
Abstract 081: Circle of Willis Arterial Size is Associated with Symptomatic Status in Chronic Carotid Occlusions
Abstract   Open access   Peer reviewed

Abstract 081: Circle of Willis Arterial Size is Associated with Symptomatic Status in Chronic Carotid Occlusions

M Galecio-Castillo, A Bajrami, R Krug, L Cruz-Criollo, P Kalakoti, S Geyik and S Ortega-Gutierrez
Stroke: vascular and interventional neurology, Vol.4(S1)
11/01/2024
DOI: 10.1161/SVIN.04.suppl_1.081
PMCID: PMC12773903
url
https://doi.org/10.1161/SVIN.04.suppl_1.081View
Published (Version of record) Open Access

Abstract

IntroductionPatients with chronic carotid occlusion (CCO) may present as either symptomatic or asymptomatic, with significant differences in prognosis and treatment strategies between these groups. Anterograde collateral circulation, particularly through the Circle of Willis (CoW), is essential for sustaining adequate cerebral blood flow in CCO patients. This study aimed to evaluate the association between collateral pathways within the CoW and the symptomatic status of patients with CCO.MethodsThis retrospective cohort study was conducted across two large comprehensive stroke centers in Turkey and the US. We included CCO patients treated between January 2018 and December 2023. The Circle of Willis (CoW) was assessed using a combination of CTA, MRA, and DSA, focusing on the visualization and diameter of the anterior communicating artery (AcoA), the first segment of the anterior cerebral artery (A1), the posterior communicating artery (PcoA), the first segment of the posterior cerebral artery (P1), the ophthalmic artery (OA), and the fetal posterior cerebral artery (FPCA). Symptomatic status was defined as any TIA/stroke ipsilateral to the occluded ICA, in the period between CCO diagnosis and last follow‐up. Contralateral ICA stenosis was measured as per the NASCET criteria, and good collateral status was determined by 3‐5 as per the angiography score developed by Souza et al. Inverse probability of treatment weighted was used to match for the following covariates: Age, sex, smoking, and basal mRS. After matching, multivariable survey‐weighted generalized logistic models were used to estimate the association between arteries size and symptomatic CCO.Results205 patients were included in the study, of whom 153 were symptomatic and 52 asymptomatic. The median age was 67 yrs. [IQR 59–76], and 26.8% were women. Patients in the symptomatic group were younger (median age 64 yrs. [58‐72] vs. 75 [68‐80], p<0.001); had lower rates of prior treatment with antiplatelets (63.4% vs. 84.6%, p=0.04) and contralateral ICA severe stenosis (>70% by NASCET criteria) (16.5% vs. 30%, p=0.010). After matching and adjusting for contralateral ICA stenosis and collateral status, we observed that larger diameters of the AcoA (1.91 vs. 1.64 mm, aOR 0.13, p=0.001), the A1 (1.91 vs. 1.81 mm, aOR 0.12, p=0.018), and the PcoA (1.49 vs. 1.28 mm, aOR 0.12, p=0.005), were negatively associated with symptomatic status (Figure 1).ConclusionThe size of the arteries within the Circle of Willis, serving as a surrogate for anterograde flow, may represent an important parameter to consider in identifying high‐risk patients who may not respond adequately to medical therapy.
 Asymptomatic Veins & arteries

Details

Metrics

13 Record Views
Logo image