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EXPRESS: Reclassifications of ischemic stroke patterns due to variants of the Circle of Willis
Abstract
Background: Variants of the Circle of Willis (vCoW) may impede correct identification of ischemic lesion patterns and stroke aetiology. We assessed reclassifications of ischemic lesion patterns due to vCoW.
Methods: We analysed vCoW in patients with acute ischemic stroke from the 1000+ study using time-of-flight magnetic resonance angiography (TOF MRA) of intracranial arteries. We assessed A1 segment agenesis or hypoplasia in the anterior circulation and fetal posterior cerebral artery (fPCA) in the posterior circulation. Stroke patterns were classified as one or more-than-one territory stroke pattern. We examined associations between vCoW and stroke patterns and the frequency of reclassifications of stroke patterns due to vCoW.
Results: Of 1000 patients, 991 had evaluable MRA. At least one vCoW was present in 37.1%. VCoW were more common in the posterior than in the anterior circulation (33.3% vs. 6.7%). Of 238 patients initially thought to have a more-than-one territory stroke pattern, 20 (8.4%) had to be reclassified to a one territory stroke pattern after considering vCoW. All these patients had fPCA and 6 (30%) additionally had carotid artery disease. Of 753 patients initially presumed to have a one-territory stroke pattern, 4 (0.5%) were reclassified as having more-than-one territory pattern.
Conclusions: VCoW are present in about one in three stroke patients and more common in the posterior circulation. Reclassifications of stroke lesion patterns due to vCoW occurred predominantly in the posterior circulation with fPCA mimicking multiple territory stroke pattern. Considering vCoW in these cases may uncover symptomatic carotid disease.
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