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Research ArticleORIGINAL RESEARCH

Circle of Willis Variants and Their Association with Outcome after Successful Revascularization of Anterior Large Vessel Occlusion

Aakanksha Sriwastwa, Michael K. Oswald, Achala S. Vagal, Stacie L. Demel, Bin Zhang, Sriharsha Voleti, Arafat Ali, Daniel Morgan, Trevor Thompson, Johnathan Vidovich, Yasmin N. Aziz and Lily Li-Li. Wang
American Journal of Neuroradiology January 2025, ajnr.A8643; DOI: https://doi.org/10.3174/ajnr.A8643
Aakanksha Sriwastwa
1Department of Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
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Michael K. Oswald
1Department of Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
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Achala S. Vagal
1Department of Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
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Stacie L. Demel
2Department of Neurology and Rehabilitation Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
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Bin Zhang
3University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
4Division of Biostatistics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
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Sriharsha Voleti
5Department of Diagnostic Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Arafat Ali
6Department of Diagnostic Radiology, Henry Ford Medical Center, Ann Arbor, Michigan, USA
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Daniel Morgan
1Department of Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
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Trevor Thompson
7Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Oregon, USA.
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Johnathan Vidovich
1Department of Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
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Yasmin N. Aziz
2Department of Neurology and Rehabilitation Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
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Lily Li-Li. Wang
1Department of Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
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ABSTRACT

BACKGROUND AND PURPOSE: Leptomeningeal collaterals have been associated with better outcomes in large-vessel stroke, but little is known about how the Circle of Willis (CoW) collaterals affect stroke outcomes. We aimed to determine the relationship between three anatomically distinct CoW subtypes and 90-day outcomes in acute ischemic stroke patients after successful revascularization via endovascular thrombectomy (EVT).

MATERIALS AND METHODS: We performed a retrospective analysis of patients treated with successful EVT for large-vessel occlusion at a comprehensive stroke center between May 2016 and November 2023. The CoW anatomy was trichotomized using baseline computed tomography angiography as follows: (I) complete CoW (C-CoW), (II) non-isolating incomplete CoW (NI-CoW), and (III) isolating incomplete CoW (I-CoW). Chi-squared and logistic regression analyses were utilized to determine the association of the CoW subtype with two co-primary outcomes: the 90-day modified Rankin Scale and 90-day mortality.

RESULTS: A total of 465 patients were included in the analysis. Multivariable logistic regression analysis demonstrated a significant association between I-CoW and 90-day mRS compared to NI-CoW [OR (95% CI), 1.83 (1.08-3.09); p=0.02]. Additionally, I-CoW anatomy was associated with a higher 90-day mortality than C-CoW [OR (95%CI), 2.58 (1.01-6.60); p=0.04] and NI-CoW [OR (95% CI), 1.89 (1.13-3.18); p=0.01].

CONCLUSIONS: CoW variants are associated with functional and mortality outcomes in patients treated with endovascular thrombectomy for anterior circulation large vessel occlusion. Further research is needed to determine how CoW vessel anatomy may impact clinical assessment, triage, and treatment in acute ischemic stroke.

ABBREVIATIONS: CoW = Circle of Willis; EVT = endovascular thrombectomy; C-CoW = complete Circle of Willis; NI-CoW = non-isolating incomplete Circle of Willis; I-CoW = isolating Circle of Willis; AIS = acute ischemic stroke; LVO = large vessel occlusion; ACom = anterior communicating artery; PCom = posterior communicating artery; Tan CS = Tan collateral scores; ACA = anterior cerebral artery; PCA = posterior cerebral artery.

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Accepted Manuscript
Aakanksha Sriwastwa, Michael K. Oswald, Achala S. Vagal, Stacie L. Demel, Bin Zhang, Sriharsha Voleti, Arafat Ali, Daniel Morgan, Trevor Thompson, Johnathan Vidovich, Yasmin N. Aziz, Lily Li-Li. Wang
Circle of Willis Variants and Their Association with Outcome after Successful Revascularization of Anterior Large Vessel Occlusion
American Journal of Neuroradiology Jan 2025, ajnr.A8643; DOI: 10.3174/ajnr.A8643

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Accepted Manuscript
Circle of Willis Variants and Their Association with Outcome after Successful Revascularization of Anterior Large Vessel Occlusion
Aakanksha Sriwastwa, Michael K. Oswald, Achala S. Vagal, Stacie L. Demel, Bin Zhang, Sriharsha Voleti, Arafat Ali, Daniel Morgan, Trevor Thompson, Johnathan Vidovich, Yasmin N. Aziz, Lily Li-Li. Wang
American Journal of Neuroradiology Jan 2025, ajnr.A8643; DOI: 10.3174/ajnr.A8643
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