scholarly journals Reclassifications of ischemic stroke patterns due to variants of the Circle of Willis

2021 ◽  
pp. 174749302110483
Author(s):  
Ida Rangus ◽  
Lennart S Milles ◽  
Ivana Galinovic ◽  
Kersten Villringer ◽  
Heinrich J Audebert ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Circle Of Willis ◽  
Posterior Circulation ◽  
Correct Identification ◽  
Anterior Circulation ◽  
Ischemic Lesion

Background Variants of the Circle of Willis (vCoW) may impede correct identification of ischemic lesion patterns and stroke etiology. We assessed reclassifications of ischemic lesion patterns due to vCoW. Methods We analyzed vCoW in patients with acute ischemic stroke from the 1000+ study using time-of-flight magnetic resonance angiography (TOF MRA) of intracranial arteries. We assessed A1 segment agenesis or hypoplasia in the anterior circulation and fetal posterior cerebral artery in the posterior circulation. Stroke patterns were classified as one or more-than-one territory stroke pattern. We examined associations between vCoW and stroke patterns and the frequency of reclassifications of stroke patterns due to vCoW. Results Of 1000 patients, 991 had evaluable magnetic resonance angiography. At least one vCoW was present in 37.1%. VCoW were more common in the posterior than in the anterior circulation (33.3% vs. 6.7%). Of 238 patients initially thought to have a more-than-one territory stroke pattern, 20 (8.4%) had to be reclassified to a one territory stroke pattern after considering vCoW. All these patients had fetal posterior cerebral artery and six (30%) additionally had carotid artery disease. Of 753 patients initially presumed to have a one-territory stroke pattern, four (0.5%) were reclassified as having more-than-one territory pattern. Conclusions VCoW are present in about one in three stroke patients and more common in the posterior circulation. Reclassifications of stroke lesion patterns due to vCoW occurred predominantly in the posterior circulation with fetal posterior cerebral artery mimicking multiple territory stroke pattern. Considering vCoW in these cases may uncover symptomatic carotid disease.

Dominant Ipsilateral Posterior Cerebral Artery on Magnetic Resonance Angiography in Acute Ischemic Stroke

2004 ◽  
Vol 18 (2) ◽  
pp. 91-97 ◽  
Author(s):  
Ju-Hun Lee ◽  
Sun-Jung Han ◽  
Woo-Youl Kang ◽  
Ki Hyeong Lee ◽  
Kyung-Ho Yu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Acute Ischemic Stroke ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery

scholarly journals Fetal posterior communicating artery as a conduit for concurrent anterior and posterior circulation infarct: A case report

2021 ◽  
Vol 3 (4) ◽  
pp. 7-11
Author(s):  
Mohamed Azlam Mohamed Micdhadhu ◽  
Ko Hin Kho ◽  
Mazeda Murad ◽  
Irene Looi
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Sudden Onset ◽  
Posterior Circulation ◽  
Posterior Communicating Artery ◽  
Left Middle Cerebral Artery ◽  
Anterior Circulation ◽  
Stroke Treatment

Fetal type posterior cerebral artery (FTPCA) is a variant of posterior circulation of brain, in which the distal part of posterior cerebral artery (PCA) is perfused by a branch of internal carotid artery (ICA) via fetal posterior communicating artery (fetal PCOM). In the presence of fetal PCOM, a paradoxical concurrent infarction of anterior and posterior circulation may happen. We report a 67-year-old man who presented with sudden onset right sided weakness and aphasia, with National Institutes of Health Stroke Scale (NIHSS) score of 22 and clinically diagnosed to have left total anterior circulation infarct (TACI). Subsequently, he received IV Alteplase as a standard hyperacute ischemic stroke treatment. Computed tomography angiography (CTA) of brain showed left FTPCA with prominent left fetal PCOM. Subsequent computed tomography (CT) of brain showed concurrent left middle cerebral artery (MCA) and PCA territories infarct. CTA brain is commonly done in ischemic stroke cases to assess presence of large vessel occlusions and intracranial or extracranial atherosclerotic disease. However, this case depicts its additional role in detecting anatomical variants of cerebral circulation. In terms of clinical importance, presence of multiple territories infarction portends a poorer neurological outcome.

scholarly journals Accuracy of Transcranial Doppler Ultrasound Compared with Magnetic Resonance Angiography in the Diagnosis of Intracranial Artery Stenosis

2019 ◽  
Vol 10 (03) ◽  
pp. 400-404
Author(s):  
Sandip Kumar Jaiswal ◽  
Yan Fu-ling ◽  
Lihua Gu ◽  
Renardo Lico ◽  
Fu Changyong ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Cerebral Artery ◽  
Transcranial Doppler ◽  
Posterior Circulation ◽  
Intracranial Artery ◽  
Anterior Circulation ◽  
Predictive Values ◽  
Intracranial Artery Stenosis ◽  
Sensitivity Specificity

Abstract Background One of the most common causes of acute cerebral infarction (ACI) is intracranial artery stenosis (ICAS). The goal of our study was to evaluate the accuracy of transcranial Doppler (TCD) compared with magnetic resonance angiography (MRA) for diagnosing ICAS in patients with ACI. Materials and Methods Consecutive patients presenting with ACI to the neurology department underwent both MRA and TCD examination within 6 hours of difference. To calculate the agreement between the results of MRA and TCD, kappa coefficient test was used. Sensitivity, specificity, and positive and negative TCD predictive values have been calculated in comparison with MRA. Results A total of 115 patients was included. There were 77 males (66.95%) and 38 females (33.04%). The mean age of patients was 68.32 ± 10.66 years (range 29–80). The agreement between TCD and MRA in detecting stenosis was 0.56 for anterior circulation artery (ACA), and 0.40 for posterior circulation artery. For the detection of ICAS, sensitivity, specificity, positive predictive value, and negative predictive values were 85.9, 90.0, 98.2, and 50.0% for anterior cerebral artery and 73.5, 86.7, 96.2, and 40.0% for posterior cerebral artery, respectively. Conclusions Moderate agreement of anterior circulation stenosis and fair agreement for posterior circulation stenosis was found between TCD and MRA in the evaluation of ICAS. In anterior circulation, the diagnostic accuracy of TCD is higher compared with the posterior circulation.

scholarly journals Role of Noninvasive Imaging of Cerebral Arterial System in Ischemic Stroke: Comparison of Transcranial Color-coded Doppler Sonography with Magnetic Resonance Angiography

2018 ◽  
Vol 8 ◽  
pp. 19 ◽  
Author(s):  
Betty Simon ◽  
Sunithi Elizabeth Mani ◽  
Shyamkumar Nidugala Keshava ◽  
Mathew Alexander ◽  
Sanjith Aaron
Keyword(s):  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Cerebral Artery ◽  
Doppler Sonography ◽  
Arterial System ◽  
Care Hospital ◽  
Intracranial Atherosclerosis ◽  
Topographical Distribution ◽  
Intracranial Circulation

Aim: To determine the accuracy of transcranial color-coded Doppler sonography (TCCS) in the evaluation of cerebral arterial system in patients with ischemic stroke attending a tertiary care hospital in South India. Objectives: (1) To describe the topographical distribution of atherosclerotic lesions in the cerebral circulation in patients presenting with ischemic stroke from the Indian subcontinent and (2) to determine the accuracy of TCCS for detection and quantification of intracranial stenoses in various segments of the intracerebral arterial system in comparison with magnetic resonance angiography (MRA). Materials and Methods: The demographic profile and risk factors of consecutive patients who presented to neurology outpatient department with cerebral ischemia and scheduled for MRA were determined. These patients had undergone neck Doppler, TCCS, and MRA. The agreement between the MRA and TCCS was assessed using kappa statistics. The sensitivity, specificity, and positive and negative predictive values of TCCS as compared to MRA were calculated. Results: Ninety patients were included in the final analysis. Intracranial atherosclerosis was found in 35.6% of cases. The agreement between TCCS and MRA in detecting lesions for the different arterial segments in the intracranial circulation was 0.83 for anterior cerebral artery (ACA), 0.66 for M1 segment of middle cerebral artery (MCA), 0.45 for M2 segment of MCA, 0.86 for terminal internal carotid artery (TICA), 0.46 for posterior cerebral artery (PCA), and 0.81 for vertebral artery (VA). The sensitivity for the detection of hemodynamically significant arterial lesions in different vascular segments was 100%, 70%, 33.3%, 90.9%, 33.3%, and 72.7% for ACA, M1, M2, TICA, PCA, and VA, respectively. Conclusion: Intracranial atherosclerosis was found to be the predominant distribution of cerebral atherosclerosis. TCCS is a safe method for evaluation of proximal basal cerebral arteries in the intracranial circulation with relatively better sensitivity in the anterior circulation.

Abstract TP400: The Differences of Vessel Wall Features Between the Anterior and Posterior Brain Arteries Detected by High Resolution Magnetic Resonance Imaging in Patients With Acute Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Xiangyan Chen ◽  
Lu Zheng ◽  
Jia LI ◽  
Wenjie Yang
Keyword(s):  
Magnetic Resonance Imaging ◽  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
High Resolution ◽  
Acute Ischemic Stroke ◽  
Vessel Wall ◽  
Posterior Circulation ◽  
Intraplaque Hemorrhage ◽  
Resonance Imaging ◽  
Anterior Circulation

Backgrounds: The purpose of this study was to investigate vessel wall features visualization by high resolution magnetic resonance imaging (HRMRI) in a series of ischemic stroke patients and to identify differences between lesions in the anterior and posterior circulation. Methods: We consecutively recruited Chinese patients with acute ischemic stroke or transient ischemic attack from 2016 to 2018. All patients were scanned at 3T magnetic resonance imaging. We evaluated pre-and post-contrast cross-sectional views of M1 and M2 segments of middle cerebral arteries (MCAs), basilar arteries (BA) and V4 segments of vertebral arteries (VAs). Results: A total of 74 patients (males 52.3%; median age 62 years old) were included in this study, among which, 234 lesions were identified on HRMRI, including 117 MCA lesions, 26 BA lesions, and 91 VA lesions. The sensitivity and specificity of MRA for diagnosing stenosis in anterior circulation were 89.3% (95% CI, 81.8%- 94.2%) and 50.0 (95% CI, 9.2%- 90.8%). The sensitivity and specificity of MRA for diagnosing stenosis in posterior circulation were 73.2% (95% CI, 63.9%- 80.9%) and 40.0 (95% CI, 7.3%- 83.0%). VA had a significantly higher contrast enhancement index (43.71± 7.74, p <0.016) than MCA (23.32± 2.46) or BA (22.69± 5.31) . Anterior circulation plaques had higher degree of stenosis (anterior versus posterior: 68.5% vs. 62.9%, p =0.036), more eccentric distribution (anterior versus posterior: 70.1% versus 53.8%, p =0.015) and higher rate of intraplaque hemorrhage (anterior versus posterior: 17.1% versus 7.7%, p =0.046). The plaques in posterior circulation had a thicker lesion wall (posterior versus anterior 16.58± 8.25 mm 2 vs. 9.10± 4.07 mm 2 , p <0.001) and higher enhancement index (posterior versus anterior 39.04± 8.50 vs. 23.32± 2.46, p <0.001) than the plaques in anterior circulation. Conclusions: The lesions in posterior circulations could be obscure on MRA. The area stenosis, intraplaque hemorrhage and enhancement index differed between circulations.

scholarly journals Posterior cerebral artery stenosis and posterior circulation revascularization surgery in pediatric patients with moyamoya disease

2018 ◽  
Vol 21 (6) ◽  
pp. 632-638 ◽  
Author(s):  
Tomomi Kimiwada ◽  
Toshiaki Hayashi ◽  
Reizo Shirane ◽  
Teiji Tominaga
Keyword(s):  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Pediatric Patients ◽  
Posterior Cerebral Artery ◽  
Posterior Circulation ◽  
Initial Diagnosis ◽  
Occipital Artery ◽  
Anterior Circulation ◽  
Before And After ◽  
Revascularization Surgery

OBJECTIVESome pediatric patients with moyamoya disease (MMD) present with posterior cerebral artery (PCA) stenosis before and after anterior circulation revascularization surgery and require posterior circulation revascularization surgery. This study evaluated the factors associated with PCA stenosis and assessed the efficacy of posterior circulation revascularization surgery, including occipital artery (OA)–PCA bypass, in pediatric patients with MMD.METHODSThe presence of PCA stenosis before and after anterior circulation revascularization surgery and its clinical characteristics were investigated in 62 pediatric patients (< 16 years of age) with MMD.RESULTSTwenty-three pediatric patients (37%) with MMD presented with PCA stenosis at the time of the initial diagnosis. A strong correlation between the presence of infarction and PCA stenosis before anterior revascularization was observed (p < 0.001). In addition, progressive PCA stenosis was observed in 12 patients (19.4%) after anterior revascularization. The presence of infarction and a younger age at the time of initial diagnosis were risk factors for progressive PCA stenosis after anterior revascularization (p < 0.001 and p = 0.002, respectively). Posterior circulation revascularization surgery, including OA-PCA bypass, was performed in 9 of the 12 patients with progressive PCA stenosis, all of whom showed symptomatic and/or radiological improvement.CONCLUSIONSPCA stenosis is an important clinical factor related to poor prognosis in pediatric MMD. One should be aware of the possibility of progressive PCA stenosis during the postoperative follow-up period and consider performing posterior circulation revascularization surgery.

Posterior cerebral artery dissection on a serial magnetic resonance angiography

2012 ◽  
Vol 34 (5) ◽  
pp. 396-399 ◽  
Author(s):  
Toshiki Takenouchi ◽  
Sachiko Shimozato ◽  
Hirokazu Fujiwara ◽  
Suketaka Momoshima ◽  
Takao Takahashi
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Artery Dissection ◽  
Cerebral Artery Dissection

Magnetic Resonance Angiography of a Posterior Cerebral Artery Occlusion

1991 ◽  
Vol 1 (2) ◽  
pp. 100-102
Author(s):  
Daniel H. Golwyn ◽  
Carlos A. Cardenas ◽  
F. Reed Murtagh ◽  
Stephen M. Sergay
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Artery Occlusion ◽  
Cerebral Artery Occlusion

Abstract TMP40: Revascularization in Patients with Moyamoya Decreases Abnormally High Posterior Circulation Arterial Flows Measured by Quantitative Magnetic Resonance Angiography

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Ramon Navarro ◽  
Robert Lober ◽  
Abdullah Feroze ◽  
Nadia Khan ◽  
Gary K Steinberg
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Moyamoya Disease ◽  
Basilar Artery ◽  
Posterior Cerebral Artery ◽  
Posterior Circulation ◽  
Arterial Circulation ◽  
Non Invasive ◽  
Post Surgery ◽  
Before And After

Introduction: Moyamoya disease and syndrome are well known to affect the anterior cerebral circulation by progressive steno-occlusive disease of the supraclinoid internal carotid arteries. Less attention has been paid to changes in posterior arterial circulation hemodynamics in this condition. We sought to better understand the latter by using a relatively novel non-invasive imaging technique: quantitative magnetic resonance angiography (qMRA). Hypothesis: We assessed the utility of qMRA to detect changes in arterial posterior arterial circulation flows before and after surgical revascularization. Methods: Retrospective review of patients who met the following inclusion criteria: (1) diagnosis of moyamoya disease or syndrome with revascularization surgery at the Stanford University between September 2008 and March 2012; (2) preoperative and postoperative qMRA scans on record within a two-year time frame; and (3) high-quality qMRA images without motion artifact. Cerebral blood-vessel flow was quantified after non-contrast magnetic resonance imaging through the use of a commercially available software tool: non-invasive optimal vessel analysis (NOVA, VasSol, Chicago, USA). Results: A total of 191 patients underwent 281 surgeries in this period of time. Of these, a cohort of 64 patients (78% female, mean age 38.5 years, 55% unilateral disease) had preoperative and postoperative qMRA studies. Preoperative arterial flows in the posterior circulation were markedly elevated compared to normative data. These flows significantly decreased after revascularization (94% direct STA-MCA bypass): right posterior cerebral artery 145 ml/min pre-surgery, 123 ml/min post-surgery, p=0.005; basilar artery 264 ml/min pre-surgery, 222ml/min post-surgery, p=0.0038. Conclusion: Quantitative MRA shows that posterior circulation arterial flows are markedly increased in patients with moyamoya. After revascularization, there is an overall decrease in these flows that is significant in the basilar artery and right posterior cerebral artery. Further use of qMRA might be warranted to better understand moyamoya hemodynamics before and after surgery.

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