Differentiating Carotid Terminus Occlusions into Two Distinct Populations Based on Willisian Collateral Status.
- Author:
Sun Uk LEE
1
;
Ji Man HONG
;
Sun Yong KIM
;
Oh Young BANG
;
Andrew M DEMCHUK
;
Jin Soo LEE
Author Information
- Publication Type:Original Article
- Keywords: Cerebral infarction; Carotid artery thrombosis; Endovascular procedures; Circle of Willis; Collateral circulation
- MeSH: Angiography; Anterior Cerebral Artery; Carotid Artery Thrombosis; Carotid Artery, Internal; Cerebral Infarction; Circle of Willis; Collateral Circulation; Endovascular Procedures; Humans; Mortality; Posterior Cerebral Artery; Retrospective Studies
- From:Journal of Stroke 2016;18(2):179-186
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND AND PURPOSE: The outcomes of acute internal carotid artery (ICA) terminus occlusions are poor. We classified ICA terminus occlusions into 2 groups according to the occlusion pattern of the circle of Willis and hypothesized that clinical outcomes would significantly differ between them. METHODS: Consecutive patients with acute ICA terminus occlusions evaluated by baseline computed tomographic angiography were enrolled. We investigated the occlusion patterns in the circle of Willis, retrospectively classified patients into simple ICA terminus occlusion (STO; with good Willisian collaterals from neighboring cerebral circulation) and complex ICA terminus occlusion (CTO; with one or more of A2 anterior cerebral artery, fetal posterior cerebral artery occlusion, or hypoplastic/absent contralateral A1; or with poor collaterals from anterior communicating artery) groups, and compared their baseline characteristics and outcomes. RESULTS: The STO group (n=58) showed smaller infarct volumes at 72 hours than the CTO group (n=34) (median, 81 mL [interquartile range, 38-192] vs. 414 mL [193-540], P<0.001) and more favorable outcomes (3-month modified Rankin Scale 0-3, 44.8% vs. 8.8%, P<0.001; 3-month mortality, 24.1% vs. 67.6%, P<0.001). In multivariable analyses, STO remained an independent predictor for favorable outcomes (odds ratio 6.1, P=0.010). CONCLUSIONS: Favorable outcomes in STO group suggested that the outcomes of acute ICA terminus occlusions depend on Willisian collateral status. Documenting the subtypes on computed tomographic angiography would help predict patient outcome.
