| Objectives:The pial collateral circulation has been shown to be closely related to the prognosis of ischemic stroke.The circle of willis,which is also used as a collateral circulation,has been considered to exert collateral compensatory effects only in aortic stenosis.The relationship between the prognosis of ischemic stroke and circle of willis is less studied,especially in people without thrombolysis and endovascular treatment..The variation of the circle of willis is complex.Circle of willis is currently classified mainly based on its integrity.This article mainly discusses the relationship between the integrity of circle of willis and the prognosis of ischemic stroke,in order to providing a basis for clinical judgment of the severity of patients with ischemic stroke and predicting their short-term prognosis.Method:This study collected patients with acute ischemic stroke who had not received thrombolysis and endovascular treatment from October 2017 to September2018 in the neurology department of the Zhongda Hospital affiliated to Southeast University.The time from onset to visit was in 1 weeks,the mRS before onset was 0.Detailed clinical data were collected from the hospital after admission,including risk factors for cerebrovascular disease,laboratory and imaging studies,and the National Institutes of Health Stroke Scale(NIHSS)scores at admission and discharge.Follow-up records of the modified Rankin score(MRS)at 3 months of onset were collected.According to the mRS score,the clinical prognosis at 3 months was divided into two outcomes:good prognosis and poor prognosis.The circle of willis was simply divided into intact and incomplete types based on magnetic resonance angiography(MRA).Univariate analysis was used to compare the differences between the general clinical data of the overall stroke population between the two types and the difference in the incidence of good prognosis.Multivariate binomial logistic regression analysis was performed.Based on MRA,circle of willis is divided into type I(the front and rear parts are intact),type II(the front part is intact and rear part is incomplete),type III(the front part is incomplete and rear part is intact)and type IV(the front and rear part is incomplete).Univariate analysis was used to compare the general clinical data of the overall stroke population between the four types and the difference in the incidence of good prognosis.Multivariate binomial logistic regression analysis was also performed.The patient population was divided into light stroke and moderate to severe stroke according to the admission NIHSS score.According to OCSP imaging classification,the patient population was divided into complete anterior circulation infarction(TACI),partial anterior circulation infarction(PACI),posterior circulation infarction(POCI),and lacunar infarction(LACI).According to the affected arterial system,the patient population was divided into internal carotid artery ischemic stroke and vertebrobasilar ischemic stroke.The difference in the incidence of good prognosis was analysed in different type of circle of willis in different affected arterial populations,different severity populations,and different OCSP imaging classification populations.The significance level of this study was set to 0.05.Results:A total of 311 patients were included in this study.There were 57 cases(18.3%)of intact type and 254 cases(81.7%)of intact type.There were 57 cases(18.3%)of type I,53 cases(17.0%)of type II,85 cases(27.3%)of type III cerebral arterial ring group,and 116 cases(37.3%)of type IV of circle of willis.1.Comparing baseline data between groups,NIHSS scores at admission(Z=-4.26,P<0.001)and NIHSS scores at discharge(Z=-2.11,P=0.035)between intact and incomplete type of circle of willis had a statistical difference,and the score of complete type was lower than the incomplete type.There was a statistically significant difference in the incidence of good prognosis between the intact and incomplete types of circle of willis at 3 months after onset(X~2=26.94,P<0.001).Logistic regression analysis indicated that the risk of poor prognosis of incomplete circle of wills was 6.19 times higher than that of the intact circle of willis(OR=6.19,95%CI 1.66-23.10,P=0.007).2.Comparing baseline data between type I-IV group,the distribution of NIHSS scores between the four groups of circle of willis(Z=22.72,P<0.001)was statistically different.The remaining baseline data were not statistically difference(P>0.05).There was a statistically significant difference in the good prognosis between the groups(X~2=33.56,P<0.001).Further,there was a statistical difference between type I and type IV,type I and type III by the Bonferroni method(P is less than 0.0083),there was no statistical difference between the other two groups(P greater than 0.0083).Logistic regression analysis indicated that the risk of poor prognosis increased by 7.75 and8.61 times by comparing type III(OR=7.75,95%CI 1.80-33.45,P=0.006)and type IV(OR=8.61,95%CI 1.94-23.22,P=0.005)with type I,indicating that the integrity of the circle of willis,especially the integrity of anterior part,is closely related to the prognosis of patients with acute ischemic stroke.3.There was a statistically significant difference in the prognosis between different types of circle of willis in the mild stroke(X~2=13.89,0.003)and the moderate to severe stroke(X~2=20.92,P<0.001).4.The difference in the good prognosis between intact and incomplete circle of willis in PACI(X~2=9.72,P=0.002),POCI(X~2=5.85,P=0.016),LACI(X~2=12.00,P=0.001)are statistical differences.There was no significant difference in the incidence of good prognosis between the intact and incomplete circle of willis in the TACI(Fisher exact probability,P=0.546).5.In the internal carotid artery ischemic stroke population(X~2=13.89,P=0.003),the good prognosis of different types of circle of willis was statistically different.There was no significant difference in the prognosis of different types of circle of willis in the vertebral basilar artery ischemic stroke population(X~2=4.97,P=0.18).Conclusion:The study concluded that the integrity of the circle of willis is closely related to the severity of neurological injury and prognosis in patients with acute ischemic stroke,the integrity of the anterior part is related to prognosis.The results of light stroke and moderate to severe stroke were consistent with the conclusions of the overall population study.Considering the small sample size,poor prognosis of complete anterior infarction,and confounding factors,this study still believes that the integrity of cerebral arteries in different OCSP imaging phenotypes is related to prognosis,which is consistent with the overall population and needs further verification.Considering the correlation between circle of willis and posterior circulation ischemia,the small sample size and possible confounding factors,this study still considers the relationship between circle of willis and prognosis in different affected arterial systems is consistent with the overall population and needs further verification.The circle of willis may not only have a dual pathway to provide compensatory effects,but may also alleviate the effects of reperfusion injury by balancing intracranial blood flow to regulate blood vessels. |
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