Incomplete Circle Of Willis Variants And Outcome Of Acute Infarction With Single Lesion

ObjectiveTo investigate the integrity of circle of Willis with first single focal cerebral infarction,and to explore the relationship between circle of Willis variants and first single acute infarction outcome.MethodsA total of 252 patients with first-ever single acute cerebral infarction who were hospitalized in Hebei General Hospital from October 2021 to September 2022 were collected.The general information of the patients at admission was recorded,including age,gender,and related vascular risk factors,including diabetes,hypertension,drinking history,smoking history,hyperlipidemia,hyperhomocysteinemia,etc.The symptoms and signs of the patients were recorded,the NIHSS score was collected after admission,and the head DWI and MRA or CTA imaging were observed.The integrity of Willis’ circle was evaluated according to the MRA or CTA data of the patient’s head.According to the location of the lesion,the patients were divided into left anterior circulation group,right anterior circulation group,left posterior circulation group and right posterior circulation group.The outcome of acute cerebral infarction at discharge was evaluated according to the mRS Scoring method.SPSS 26.0 was used for statistical analysis of the data.Chi-square test was used for measurement data.If the distribution did not follow the normal distribution,the median and the upper and lower quartile [M(Q1,Q3)] were used.The difference was analyzed by nonparametric rank sum test,and the relationship between multiple variables and binary variables was analyzed by variables was analyzed by Logistic regression,P<0.05 was statistically significant.A total of 252 patients with first-ever single acute cerebral infarction who were hospitalized in Hebei General Hospital from October 2021 to September 2022 were collected.The general information of the patients at admission was recorded,including age,gender,and related vascular risk factors,including diabetes,hypertension,drinking history,smoking history,hyperlipidemia,hyperhomocysteinemia,etc.The symptoms and signs of the patients were recorded,the NIHSS score was collected after admission,and the head DWI and MRA imaging were observed.The integrity of circle of Willis was evaluated according to the MRA data of the patient’s head.According to the location of the lesion,the patients were divided into left anterior circulation group,right anterior circulation group,left posterior circulation group and right posterior circulation group.The outcome of acute cerebral infarction at discharge was evaluated according to the m RS Scoring method.SPSS 26.0 was used to analyze the data.The count data were expressed as percentage and analyzed by chi-square test.The measurement data following normal distribution were expressed as mean± standard deviation((?)±SD)and analyzed by t test.The relationship between multiple independent variables and ordinal variables was analyzed by ordinal Logistic regression,and P<0.05 was statistically significant.ResultesGeneral information: A total of 252 patients were included in this study,including 166 males(65.87%)and 86 females(34.13%),aged from27 to 80 years,with an average age of(59.08±11.41)years.There were 68(27.00%)patients with a history of drinking,98(38.90%)patients with a history of smoking,174(69.05%)patients with hypertension,98(38.90%)patients with diabetes,71(28.20%)patients with hyperlipidemia,and 87(34.52%)patients with hyperhomocysteinemia.There was no significant difference in age,gender,drinking history,smoking history,diabetes history,hypertension,high homocysteine,and hyperlipidemia between the left anterior circulation group,right anterior circulation group,left posterior circulation group,and right posterior circulation group(P > 0.05),but there was significant difference in gender(P < 0.05).2 The complete circle of Willis was 3.97% in the study patients.In the circle of Willis,the posterior communicating artery is most likely to be absent or hypoplastic.3 After adjusting for age at admission and severity of stroke,absence OR dysplasia of the A1 segment of the left anterior cerebral artery and the left posterior communicating artery increased the risk of poor prognosis of left anterior circulation cerebral infarction(OR: 3.257,95%CI: 1.087,9.760,P=0.035).OR: 3.670,95%CI:(1.016,13.254),P=0.047);Absence OR hypoplasia of the right posterior communicating artery reduced the risk of poor prognosis of left anterior circulation cerebral infarction(OR: 0.227,95%CI:(0.064,0.801),P=0.021).Absence OR hypoplasia of P1 segment of right posterior cerebral artery increased the risk of poor prognosis of right anterior circulation cerebral infarction(OR: 8.315,95%CI:(1.280,54.028),P=0.027).However,the absence OR hypoplasia of P1 segment of the left posterior cerebral artery reduced the poor prognosis of right anterior circulation cerebral infarction(OR: 0.087,95%CI:(0.009,0.862),P=0.037).4 Pearson chi-square test or Fisher’s exact test showed that there was no significant difference in the prognosis of cerebral infarction between the intact and incomplete Willis circle in the left anterior circulation group,the right anterior circulation group,the left posterior circulation group,and the right posterior circulation group(P> 0.05).Conclusions1 Posterior communicating absence or hypoplasia is most likely to occur in the circle of Willis.2 Comparison of general data between left anterior circulation group,right anterior circulation group,left posterior circulation group and right posterior circulation group showed that there was no significant difference in age,gender,smoking history,drinking history,hypertension,diabetes history,hyperlipidemia and high homocysteine,but there was significant difference in gender.3 The variation of the circle of Willis is associated with the prognosis of the first single cerebral infarction.4 There was no significant difference in the influence of different circle of Willis structural variation on the first single cerebral infarction in different regions.