Willisian collateral and carotid stenosis during large vessel occlusion stroke: Observations from computed tomography
1Department of Medical Imaging, Western University, London, Ontario, Canada and Department of Medical Imaging, Division of Clinical Sciences, NOSM University, Sudbury,Ontario, Canada. kiwanruba@gmail.com.
Insights
Ophthalmic artery size impacts stroke severity and collateral circulation in large vessel occlusion. Larger ophthalmic arteries correlate with better outcomes, while smaller ones suggest worse stroke severity.
Area of Science:
- Neurology
- Vascular Imaging
- Stroke Medicine
Background:
- Cerebral collateral circulation is vital for acute stroke management.
- Large conducting arteries like the ophthalmic artery play a role in collateral supply.
- Understanding anatomical variations can improve stroke outcome prediction.
Purpose of the Study:
- To investigate the relationship between ophthalmic artery anatomy and stroke severity.
- To assess the correlation between ophthalmic artery diameter and cerebral collateral grading scales.
- To evaluate the impact of ophthalmic artery size on outcomes in large vessel occlusion (LVO) stroke.
Main Methods:
- Retrospective analysis of 100 endovascular thrombectomy (EVT) patients.
- Measurement of 16 large arteries (≥1 mm) from computed tomography angiography (CTA).
- Correlation of artery measurements with National Institutes of Health Stroke Scale (NIHSS), Alberta Stroke Program Early CT Score (ASPECTS), and CTA collateral scores.
Main Results:
- Ophthalmic artery diameter significantly correlates with stroke severity and collateral scores.
- Increased ophthalmic artery diameter is associated with lower NIHSS and higher ASPECTS.
- Contralateral ophthalmic artery size shows an inverse relationship with stroke severity scores.
Conclusions:
- Ophthalmic artery size is a significant determinant of native collateral status and stroke severity.
- This finding may aid in predicting stroke outcomes and guiding treatment strategies.
- Further research into vascular anatomy's role in stroke is warranted.
Objective:
The larger (≧1 mm) conducting and distributing arteries to the brain are sources of collateral during acute stroke, and include the cervical carotid, ophthalmic, and Circle of Willis (CoW) vessels. This study assessed their anatomy for relationships with stroke severity in large vessel occlusion (LVO), and with common grading scales of cerebral collateral.
Methods:
One hundred consecutive endovascular thrombectomy (EVT) patients had imaging measurements made on 16 large (≧1 mm) candidate arteries visualized on axial source computed tomography angiography (CTA). Admission National Institutes of Health Stroke Scale score (NIHSS), Alberta Stroke Program Early CT Score (ASPECTS), and multiphasic CTA collateral scores were used as outcome measures.
Results:
Ophthalmic arteries show a significant connection with stroke severity and collateral scores. A 1-mm increase in ophthalmic artery diameter leads to a lower NIHSS score of 4.8 points (p<0.008) in multivariable analysis, and 1.53-point increase in ASPECTS (p<0.001). The opposite applies to the contralateral ophthalmic: a 6.3-point higher NIHSS score and 2.6-point drop in ASPECTS.
Conclusions:
Native collateral and stroke severity scores are significantly affected by ophthalmic artery size.
