eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
Current issue Archive Manuscripts accepted About the journal Editorial board Abstracting and indexing Subscription Contact Instructions for authors
SCImago Journal & Country Rank
4/2015
vol. 11
 
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abstract:
Original paper

Low prevalence of collateral cerebral circulation in the circle of Willis in patients with severe carotid artery stenosis and recent ischemic stroke

Rafał Badacz
,
Tadeusz Przewłocki
,
Izabela Karch
,
Piotr Pieniążek
,
Agnieszka Rosławiecka
,
Szymon Mleczko
,
Andrzej Brzychczy
,
Mariusz Trystuła
,
Krzysztof Żmudka
,
Anna Kabłak-Ziembicka

Postep Kardiol Inter 2015; 11, 4 (42): 312–317
Online publish date: 2015/12/01
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Introduction: The circle of Willis is thought to play a key role in development of collateral flow in patients with internal carotid artery stenosis (ICAS).

Aim: To assess flow in the circle of Willis in patients with recent ischemic stroke (IS).

Material and methods: The study included 371 patients, 102 symptomatic with severe ICAS and recent IS (within the last

3 months) (group I) and 269 asymptomatic with severe ICAS (group II). Flow in the middle (MCA), anterior (ACA) and posterior (PCA) cerebral arteries and pattern of the cross-flow through anterior (ACoA) and posterior (PCoA) communicating arteries were assessed with transcranial color-coded Doppler ultrasonography (TCCD).

Results: The ACoA or PCoA was less prevalent in group I than in group II (54% vs. 78%, p < 0.001 and 20% vs. 42%, p < 0.001, respectively), resulting in lower peak-systolic velocity (PSV) in the MCA in group I vs. group II (p = 0.015). Any collateral pathway was present in 67% of patients in group I, compared to 86% in group II (p < 0.001). Both PSV and end-diastolic (EDV) flow velocity in the ACA were lower in patients with recent IS, compared to asymptomatic subjects (71 ±24 cm/s vs. 86 ±34 cm/s, p < 0.001 and 32 ±12 cm/s vs. 37 ±17 cm/s, p = 0.038, respectively). Presence of ACoA or PCoA and higher PSV in the MCA and ACA were associated with significant risk reduction of IS (RR = 0.28 (95% CI = 0.16–0.49, p < 0.001), RR = 0.28 (95% CI = 0.15–0.52, p < 0.001), RR = 0.97 (95% CI = 0.96–0.99, p < 0.001), RR = 0.99 (95% CI = 0.98–0.99, p < 0.032), respectively). However, ROC curves failed to show reliable MCA or ACA PSV cut-offs for IS risk assessment.

Conclusions: The ACoA and PCoA seem to play a key role in the evaluation of IS risk in subjects with severe ICAS.
keywords:

stroke, circle of Willis, collateral circulation, transcranial Doppler, carotid artery stenosis

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