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Variants of the circle of Willis in ischemic stroke patients
Jolanda De Caro1, Antonio Ciacciarelli1, Agostino Tessitore2
1UOSD Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, 98125, Messina, Italy.
Insights
Anatomical variants of the circle of Willis are more common in ischemic stroke patients than controls. These brain vascular variants were associated with older age but did not impact stroke severity or in-hospital outcomes.
Area of Science:
- Neuroimaging
- Vascular Neurology
- Cerebrovascular Anatomy
Background:
- The circle of Willis (CoW) is a critical brain vascular network.
- Anatomical variations in the CoW are common and may influence cerebral blood flow.
- Understanding these variants is important for interpreting cerebrovascular diseases like ischemic stroke.
Purpose of the Study:
- To determine the prevalence and pattern of CoW anatomical variants in ischemic stroke patients.
- To compare the frequency of these variants between ischemic stroke patients and a control group.
- To investigate the association between CoW variants and stroke severity, etiology, and in-hospital prognosis.
Main Methods:
- Retrospective analysis of vascular imaging from 1131 ischemic stroke patients and 562 controls.
- Neuroradiologists identified CoW variants using a standardized classification system.
- Data collected included patient demographics, stroke characteristics, treatment, and outcomes.
Main Results:
- A higher prevalence of CoW variants was observed in stroke patients (62.1%) compared to controls (54.8%).
- The most frequent variants were agenesis/hypoplasia of the anterior cerebral artery (ACA) and fetal-type posterior cerebral artery (PCA).
- Patients with variants were older, but no significant differences were found in sex, stroke severity, or in-hospital outcomes.
Conclusions:
- The prevalence of anatomical variants of the circle of Willis is elevated in patients with ischemic stroke.
- While variants are more common in older individuals, they do not appear to influence neurological severity or short-term prognosis.
- These findings contribute to understanding the role of cerebrovascular anatomy in ischemic stroke.
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.
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