Radiographic absence of the posterior communicating arteries and the prediction of cognitive dysfunction after carotid endarterectomy

Sussman, Eric S; Kellner, Christopher P.; Mergeche, Joanna L.; Bruce, Samuel S.; McDowell, Michael M.; Heyer, Éric; Connolly, E. Sander

doi:10.3171/2014.5.jns131736

Cited by 16 publications

(10 citation statements)

References 36 publications

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“…Type E posterior variant has been associated with increased risk of ischaemic stroke [8]. This variant is of importance to surgeons and neurologists in the evaluation of patients with intracranial tumors, traumatic injuries, and cardiovascular complications [29].…”

Section: Discussionmentioning

confidence: 99%

Proportion of Variant Anatomy of the Circle of Willis and Association with Vascular Anomalies on Cerebral CT Angiography

Machasio

Nyabanda

Mutala

2019

Radiology Research and Practice

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Background and Purpose. There is a wide variation in the anatomy of the CW in different individuals and population groups. The purpose of this study was to determine the proportion of variant anatomy of the circle of Willis (CW) and associated anomalies in patients with suspected cerebrovascular disease referred for cerebral computed tomography angiography (CTA) in two tertiary hospitals in Kenya. Methodology. This was a cross-sectional descriptive study conducted on 94 patients referred for cerebral CTA at the Kenyatta and Nairobi hospitals from August 2017 to February 2018. MIP and 3D reformatted images were analyzed by two senior radiologists to determine the final configuration of the CW and presence of vascular pathology. Vessels with diameters <0.8 mm were considered to be absent or hypoplastic. Chen et al. classification was used to determine the final configuration of CW. Results. Complete CW was seen in 37.2% (37.7% vs. 36.6% in males and females, respectively, p=0.909). Type A variant was the commonest anterior variant at 78.7%. Type E variant was the dominant posterior variant at 41.5%. Fetal PCA was demonstrated in 25.5%, unilateral > bilateral fetal PCA. Aneurysms were seen in 24.5% of patients. ACoA aneurysms were commonest at 43.6%. AVMs were seen in 8.5% of patients. Azygous ACA, fenestration, and duplication of vessels and persistent TA were not demonstrated. There is no significant association between aneurysms/AVMs and CW configuration. Conclusion. The findings in this study demonstrate slight differences in the CW configuration. A higher proportion of complete anterior CW was seen in female patients. Type A anterior and type E posterior circulation variants were the commonest in both males and females. No significant association was demonstrated between CW configuration and occurrence of aneurysms/AVMs in this study. Various methods of classification of CW configuration have been proposed with no standardized method to date, thus the need for consensus building between neuroanatomists, neurologists, neurosurgeons, and neuroradiologists for ease of comparison between similar future studies on the CW.

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Section: Discussionmentioning

confidence: 99%

Proportion of Variant Anatomy of the Circle of Willis and Association with Vascular Anomalies on Cerebral CT Angiography

Machasio

Nyabanda

Mutala

2019

Radiology Research and Practice

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“…Whenever possible, we reviewed DSAs to determine PCOMs’ patency. TOF imaging is flow-dependent, and bidirectional flow through collaterals may lead to false signal loss and mischaracterisation of the vessel as being occluded 9. Conversely, contrast-enhanced CTA and MRA depict the vascular contour based on vessel patency.…”

Section: Methodsmentioning

confidence: 99%

Stroke mechanisms and outcomes of isolated symptomatic basilar artery stenosis

et al. 2019

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BackgroundWhile diffuse atherosclerotic disease affecting the posterior circulation has been described extensively, the prevalence, natural history and angiographic characteristics of isolated symptomatic basilar artery stenosis (ISBAS) remain unknown.MethodsWe reviewed our prospective institutional database to identify patients with ≥50% symptomatic basilar artery (BA) stenosis without significant atherosclerotic burden in the vertebral or posterior cerebral arteries. Stroke mechanism, collateral circulation, and degree and length of stenosis were analysed. The primary outcome was time from index event to new transient ischaemic attack (TIA), acute ischaemic stroke (AIS) or death. Other outcome variables included modified Rankin Scale (mRS) score on discharge and last follow-up.ResultsOf 6369 patients with AIS/TIA, 91 (1.43%) had ISBAS. Seventy-three (80.2%) patients presented with AIS and 18 (19.8%) with TIA. Twenty-nine (31.9%) were women and the median age was 66.8±13.6 years. The mean follow-up time was 2.7 years. The most common stroke mechanism was artery-to-artery thromboembolism (45.2%), followed by perforator occlusion (28.7%) and flow-dependent/hypoperfusion (15.1%). The percentage of stenosis was lower in patients who had favourable outcome compared with those with mRS 3–6 on discharge (78.3±14.3 vs 86.9±14.5, p=0.007). Kaplan-Meier curves showed higher recurrence/death rates in patients with ≥80% stenosis, mid-basilar location and poor collateral circulation. Approximately 13% of patients with ISBAS presented with complete BA occlusion.ConclusionISBAS is an uncommon (1.43%) cause of TIA and AIS. Men in their 60s are mostly affected, and artery-to-artery embolism is the most common stroke mechanism. Mid-basilar location, ≥80% stenosis and poor collateral circulation are important factors associated with worse prognosis.

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“…Although cerebral hypoperfusion is common in patients with ICA stenosis, collateral circulation provides new paths to maintain sufficient blood supply even though it may only represent a poor compensation [2]. Some studies have investigated the association between collateral circulation and cognitive dysfunction in recent years; however, the findings on this topic have been inconsistent [3, 4]. Everts et al found no correlation between the formation of collaterals and cognitive function [5], while Sztriha et al proposed that collaterals-related perfusion restoration could improve the cognitive dysfunction [6].…”

Section: Introductionmentioning

confidence: 99%

Influence of collateral circulation on cerebral blood flow and frontal lobe cognitive function in patients with severe internal carotid artery stenosis

Wei

Ruan

et al. 2019

BMC Neurol

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Background: This study aimed to investigate the cerebral blood flow (CBF) and frontal lobe cognitive function in severe internal carotid artery (ICA) stenosis patients with different types of collateral circulation. Methods: One hundred twenty-six patients with severe unilateral ICA stenosis were enrolled. Digital subtraction angiography (DSA) was performed to recruit patients with one of three common types of collateral circulation: anterior communicating artery (AcoA), posterior communicating artery (PcoA) and ophthalmic artery (OA). The hemodynamic parameters of the middle cerebral artery (MCA) were measured using transcranial Doppler (TCD), and the individual frontal lobe cognitive attention functions were evaluated using Word Fluency Test, Trail-Making Test (TMT), Digit Span, and Stroop Color Word Test (SCWT). The correlation between hemodynamic changes and the scores of all tasks was analyzed. Results: On the side of arterial stenosis, the CBF velocities were highest in AcoA group and lowest in the OA group. All patients performed worse in TMT and Digit Span than the matched normal controls. The AcoA group exhibited a lower pulsatility index (PI) and a longer response time in the Stroop task, but had a higher accuracy rate in the Stroop task and higher scores in Word Fluency Test than the PcoA and OA groups. In all the three groups, PI was positively correlated with the accuracy rate for Stroop interference effects. Conclusions: Our findings suggested that the frontal lobe cognitive function of patients with ICA was impaired, and AcoA collaterals may be beneficial for selective attention functions, whereas OA collaterals may be associated with impairment of selective attention functions. Additionally, a high PI may be an indicator for identifying impaired selective attention in patients with severe ICA stenosis.

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Radiographic absence of the posterior communicating arteries and the prediction of cognitive dysfunction after carotid endarterectomy

Cited by 16 publications

References 36 publications

Proportion of Variant Anatomy of the Circle of Willis and Association with Vascular Anomalies on Cerebral CT Angiography

Proportion of Variant Anatomy of the Circle of Willis and Association with Vascular Anomalies on Cerebral CT Angiography

Stroke mechanisms and outcomes of isolated symptomatic basilar artery stenosis

Influence of collateral circulation on cerebral blood flow and frontal lobe cognitive function in patients with severe internal carotid artery stenosis

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