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Differentiating Carotid Terminus Occlusions into Two Distinct Populations Based on Willisian Collateral Status / 대한뇌졸중학회지
Journal of Stroke ; : 179-186, 2016.
Article in English | WPRIM | ID: wpr-113530
Responsible library: WPRO
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.
Subject(s)

Full text: Available Index: WPRIM (Western Pacific) Main subject: Humans / Angiography / Carotid Artery, Internal / Carotid Artery Thrombosis / Cerebral Infarction / Retrospective Studies / Mortality / Circle of Willis / Collateral Circulation / Anterior Cerebral Artery Language: English Journal: Journal of Stroke Year: 2016 Type: Article

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Full text: Available Index: WPRIM (Western Pacific) Main subject: Humans / Angiography / Carotid Artery, Internal / Carotid Artery Thrombosis / Cerebral Infarction / Retrospective Studies / Mortality / Circle of Willis / Collateral Circulation / Anterior Cerebral Artery Language: English Journal: Journal of Stroke Year: 2016 Type: Article