Association between symptomatic intracranial atherosclerotic disease and the integrity of the circle of Willis

Abstract

The relationship between the severity of intracranial atherosclerotic disease and the circle of Willis integrity is unclear. In this brief report, we investigate the associations between symptomatic intracranial atherosclerotic disease and the integrity of the circle of Willis. Patients with symptomatic intracranial atherosclerosis were enrolled and underwent intracranial artery magnetic resonance vessel wall imaging and time-of-flight angiography. The presence or absence of an intracranial atherosclerotic plaque and its maximum wall thickness and stenosis were evaluated. The presence or absence of the A1 segment of the bilateral anterior cerebral arteries (from the internal carotid artery to the anterior communicating artery segment is called anterior cerebral artery A1 segment), and anterior communicating artery, the P1 segment of the bilateral posterior cerebral arteries (The P1 segment of the posterior cerebral artery is a horizontally outward segment), and bilateral posterior communicating arteries were determined. The associations of the intracranial plaque features with the integrity of the circle of Willis were analyzed. Of the 110 recruited subjects (57.2 ± 11.1 years; 65% males), 51 had intracranial plaques, and 44 had stenosis. In patients with bilateral A1 and P1 segments (n = 85), intracranial stenosis was more severe in patients with an anterior communicating artery than those without an anterior communicating artery (19.7% ± 21.7% vs. 1.4% ± 3.3%, p = 0.046). In patients with bilateral A1 and P1 segments and an anterior communicating artery (n = 79), intracranial stenosis was more severe in patients with posterior communicating arteries than those without posterior communicating arteries (27.9% ± 23.7% vs. 13.5% ± 17.9%, p = 0.007). The odds ratio of intracranial stenosis was 1.214 (95% confidence interval (CI), 1.054--1.398; p = 0.007) in discriminating for the presence of posterior communicating arteries in patients with bilateral A1 and P1 segments and an anterior communicating artery after adjusting for confounding factors. The severity of intracranial atherosclerosis was independently associated with the presence of posterior communicating arteries in patients with a complete anterior part of the circle of Willis.

Prevalence and Characteristics of Symptomatic Intracranial Atherosclerotic Plaques in People Residing at Middle and High Altitudes: A Preliminary Study

“…Data were retrospectively collected from patients diagnosed with cerebrovascular symptoms who underwent HR-VWI examination at the Affiliated Hospital of Qinghai University between April 2020 and April 2022. The inclusion criteria encompassed: (1) the presence of intracranial atherosclerosis confirmed by HR-VWI or digital subtraction angiography (DSA) findings, (2) clinical symptoms of transient ischemic attack (TIA) or ischemic stroke attributed to plaques of atherosclerotic stenosis in the intracranial regions, (3) the presence of at least one atherosclerotic risk factor, including hypertension, diabetes mellitus, hyperlipidemia, or smoking, (4) HR-VWI examination had to be performed within 2 weeks of symptom onset, (5) patients were required to be year-round residents of Qinghai province. Exclusion criteria included: (1) stenoses exceeding 50% in the ipsilateral carotid artery and vertebral artery in the extracranial segment, (2) intracranial artery occlusion, (3) any nonatherosclerotic vascular diseases such as vasculitis, arterial dissection, thrombosis, and cardioembolism, (4) incomplete or missing clinical information or laboratory results, and (5) poor image quality.…”

“…Intracranial atherosclerotic disease (ICAD) is not only the most frequent cause of ischemic stroke (IS) but is also highly prevalent [1]. Recently, there has been an increasing focus on intracranial atherosclerotic plaques, leading to numerous domestic and international studies on the subject [2][3][4][5]. However, the majority of these studies have centered on lowland regions, with only a few conducted in middleand high-altitude areas, representing a limitation of these investigations.…”