Presence of an Anterior Communicating Artery as a Prognostic Factor in Revascularization for Anterior Circulation Acute Ischemic Stroke

No reports have evaluated collateral circulation using simpler measures involving magnetic resonance imaging. Because an anterior communicating artery (A-com) is important in collateral circulation, we investigated whether the presence of an A-com affected the clinical revascularization outcomes in acute ischemic stroke (AIS) in the anterior circulation.

The present retrospective study included 73 patients who had undergone continuous administration of recombinant tissue plasminogen activator and revascularization for AIS in the anterior circulation from April 2014 to September 2018. The presence of an A-com was evaluated using preoperative time-of-flight magnetic resonance angiography. The patient characteristics and clinical outcomes were compared, and we investigated the influence of the presence or absence of an A-com on these clinical outcomes. The clinical outcomes were analyzed using multiple logistic regression.

The clinical outcomes did not significantly correlate with age, sex, or occlusion location but did significantly correlate with the preoperative National Institute of Health stroke scale score, diffusion-weighted Alberta Stroke Program early computed tomography score, reperfusion >50% (thrombolysis in cerebral infarction grade >2b), and onset to recanalization time. The presence of an A-com correlated significantly with good clinical outcomes (modified Rankin scale score 0-3; P = 0.0081) and reduced mortality (P = 0.03). Multiple logistic regression predicted for significantly good clinical outcomes with the presence of an A-com (odds ratio, 17.03; 95% confidence interval, 1.85-157.10; P = 0.012).

The presence of an A-com on preoperative time-of-flight magnetic resonance angiography is a good prognostic factor for revascularization in patients with anterior circulation AIS, confirms collateral circulation, and allows for faster and safer endovascular treatment.