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Association of Narrow Anterior Communicating Artery or Contralateral A1 Segment with Poor Outcomes After Mechanical
Audrius Širvinskas1,2, Giedrius Ledas2, Rūta Levulienė3
1Department of Radiology, Republican Vilnius University Hospital, Šiltnamių g. 29, 04130 Vilnius, Lithuania.
Insights
Narrower contralateral A1 and anterior communicating artery (AComA) segments are linked to worse outcomes in acute ischemic stroke patients with internal carotid artery occlusion. A diameter of 1.1-1.2 mm indicates a higher risk, emphasizing the importance of collateral circulation for recovery.
Area of Science:
- Neuroscience
- Vascular Neurology
- Medical Imaging
Background:
- Contralateral A1 and anterior communicating artery (AComA) aplasia/hypoplasia significantly impact outcomes in distal internal carotid artery (ICA) T-occlusion due to compromised collateral flow.
- Existing literature uses these terms broadly; concrete measurements and clinical significance data are needed to understand their impact on patient outcomes.
- Individual variations in the circle of Willis anatomy can influence recovery after stroke.
Purpose of the Study:
- To determine cut-off values for contralateral A1 and AComA segments that predict worse outcomes in acute ischemic stroke patients with terminal ICA occlusion.
- To investigate the clinical significance of anatomical variations in the circle of Willis for stroke patients undergoing mechanical thrombectomy.
Main Methods:
- Retrospective (2015-2020) and prospective (2021-2022) data from 482 acute ischemic stroke patients undergoing mechanical thrombectomy were analyzed.
- A subset of 70 patients with internal carotid artery bifurcation occlusion extending to M1 or A1 segments were selected for detailed analysis.
- Logistic regression and Multivariate Adaptive Regression Splines (MARS) were used to identify statistically significant interactions and optimal cut-off points.
Main Results:
- The narrowest contralateral A1 and/or AComA segment diameter was statistically significant for 7-day National Institutes of Health Stroke Scale (NIHSS) scores.
- Optimal cut-off points for predicting worse outcomes were identified as 1.1 mm (MARS) and 1.2 mm (logistic regression), with p=0.0079.
- Other variables like age, gender, time to treatment, and ASPECT score did not show statistical significance in relation to outcomes.
Conclusions:
- A negative correlation exists between contralateral A1/AComA segment diameter and 7-day NIHSS, indicating narrower vessels lead to poorer outcomes.
- Larger diameters of the contralateral A1 and AComA segments are crucial for better patient outcomes at the 7-day evaluation post-mechanical thrombectomy.
- Establishing precise anatomical cut-off values aids in predicting stroke patient prognosis and guiding treatment strategies.
Abstract:
Background and Objectives: Contralateral A1 and AComA aplasia/hypoplasia are critically important in distal ICA T occlusion as the protective collateral blood supply from the circle of Willis via the anterior communicating artery is compromised. Although the terms aplasia/hypoplasia are used broadly in the literature, the need for concrete measurements and data on their clinical significance is apparent. Features of the individual anatomy of the circle of Willis may determine patient outcomes. We aim to determine the cut-off values of contralateral A1 and AComA segments that determine worse outcomes for patients with acute ischemic stroke with T occlusion of the terminal internal carotid artery. Material and Methods: Retrospective patient data from 2015 to 2020 and prospective data from 2021 to 2022 of 482 patients with diagnosed acute ischemic stroke that underwent mechanical thrombectomy at the Republican Vilnius University Hospital (Vilnius, Lithuania) were obtained. Of these patients, 70 were selected with occlusion of internal carotid artery bifurcation and extension to M1 or A1 segments. For statistically significant interactions, patient data were analyzed using two statistical methods (logistic regression and Multivariate Adaptive Regression Splines (MARS)). Results: The narrowest segment of contralateral A1 and/or AComA was statistically significant for 7-day NIHSS, and the optimal cut-off points for this variable were 1.1 mm (MARS model) and 1.2 mm (logistic regression, p = 0.0079, sensitivity 66.7%, specificity 67.9%). The other considered variables (age, gender, time from last seen well to groin puncture, intravenous recombinant tissue plasminogen activator, admission NIHSS, and ASPECT score) and their interactions were not statistically significant. Conclusions: A negative correlation was found between the narrowest segment and seven days of NIHSS. A larger diameter of contralateral A1 and AComA appears to be essential for better patient outcomes at 7-day evaluation post mechanical thrombectomy.
