Configuration of the Circle of Willis is associated with less symptomatic intracerebral hemorrhage in ischemic stroke patients treated with intravenous thrombolysis

Yu Ming Chuang, Lung Chan, Yen Jun Lai, Kuei Hong Kuo, Yih Hwa Chiou, Lih Wen Huang, Yam Ting Kwok, Tzu Hsien Lai, Siu Pak Lee, Hung Ming Wu, Yen Chi Yeh

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Backgrounds: The circle of Willis (CoW) is a primary collateral pathway that compensates quickly for a drop in cerebral blood flow. Using the complete CoW as a surrogate marker for good collateral circulation, its prognostic value after intravenous thrombolysis was examined. Methods: We prospectively studied 64 consecutive patients with acute ischemic stroke treated with tissue plasminogen activator within 3 hours of stroke onset between October 2005 and June 2012 in our hospital. The study protocol was based on standard guidelines for intravenous thrombolysis. On computed tomographic angiography 24 hours after thrombolysis, the CoW was complete in 21 (32.8%) cases and incomplete in 43 (67.2%). Results: Patients with complete CoW were more likely to have early improvement in National Institute of Health Stroke Scale (NIHSS) score (median improvement 2 vs 0 at 2 hours; 4 vs 1 at 24 hours), be independent at 3 months (42% vs 19%). In the incomplete CoW group, the rate of symptomatic intracerebral haemorrhage (SICH) according to the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) definition was almost 3 times higher. Complete CoW was one of the strongest predictors of good functional outcome at 3 months (odds ratio 2.32; P = .01). Conclusions: Complete CoW independently predicted functional independence and survival.

Original languageEnglish
Pages (from-to)166-172
Number of pages7
JournalJournal of Critical Care
Volume28
Issue number2
DOIs
Publication statusPublished - Apr 1 2013
Externally publishedYes

Fingerprint

Circle of Willis
Cerebral Hemorrhage
Stroke
Cerebrovascular Circulation
Collateral Circulation
National Institutes of Health (U.S.)
Tissue Plasminogen Activator
Angiography
Biomarkers
Odds Ratio
Guidelines
Survival

Keywords

  • Circle of Willis
  • CT angiography
  • Intravenous thrombolysis
  • Symptomatic intracerebral haemorrhage

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Configuration of the Circle of Willis is associated with less symptomatic intracerebral hemorrhage in ischemic stroke patients treated with intravenous thrombolysis. / Chuang, Yu Ming; Chan, Lung; Lai, Yen Jun; Kuo, Kuei Hong; Chiou, Yih Hwa; Huang, Lih Wen; Kwok, Yam Ting; Lai, Tzu Hsien; Lee, Siu Pak; Wu, Hung Ming; Yeh, Yen Chi.

In: Journal of Critical Care, Vol. 28, No. 2, 01.04.2013, p. 166-172.

Research output: Contribution to journalArticle

Chuang, Yu Ming ; Chan, Lung ; Lai, Yen Jun ; Kuo, Kuei Hong ; Chiou, Yih Hwa ; Huang, Lih Wen ; Kwok, Yam Ting ; Lai, Tzu Hsien ; Lee, Siu Pak ; Wu, Hung Ming ; Yeh, Yen Chi. / Configuration of the Circle of Willis is associated with less symptomatic intracerebral hemorrhage in ischemic stroke patients treated with intravenous thrombolysis. In: Journal of Critical Care. 2013 ; Vol. 28, No. 2. pp. 166-172.
@article{429f0fcacefb409dbe01c58d74bf852b,
title = "Configuration of the Circle of Willis is associated with less symptomatic intracerebral hemorrhage in ischemic stroke patients treated with intravenous thrombolysis",
abstract = "Backgrounds: The circle of Willis (CoW) is a primary collateral pathway that compensates quickly for a drop in cerebral blood flow. Using the complete CoW as a surrogate marker for good collateral circulation, its prognostic value after intravenous thrombolysis was examined. Methods: We prospectively studied 64 consecutive patients with acute ischemic stroke treated with tissue plasminogen activator within 3 hours of stroke onset between October 2005 and June 2012 in our hospital. The study protocol was based on standard guidelines for intravenous thrombolysis. On computed tomographic angiography 24 hours after thrombolysis, the CoW was complete in 21 (32.8{\%}) cases and incomplete in 43 (67.2{\%}). Results: Patients with complete CoW were more likely to have early improvement in National Institute of Health Stroke Scale (NIHSS) score (median improvement 2 vs 0 at 2 hours; 4 vs 1 at 24 hours), be independent at 3 months (42{\%} vs 19{\%}). In the incomplete CoW group, the rate of symptomatic intracerebral haemorrhage (SICH) according to the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) definition was almost 3 times higher. Complete CoW was one of the strongest predictors of good functional outcome at 3 months (odds ratio 2.32; P = .01). Conclusions: Complete CoW independently predicted functional independence and survival.",
keywords = "Circle of Willis, CT angiography, Intravenous thrombolysis, Symptomatic intracerebral haemorrhage",
author = "Chuang, {Yu Ming} and Lung Chan and Lai, {Yen Jun} and Kuo, {Kuei Hong} and Chiou, {Yih Hwa} and Huang, {Lih Wen} and Kwok, {Yam Ting} and Lai, {Tzu Hsien} and Lee, {Siu Pak} and Wu, {Hung Ming} and Yeh, {Yen Chi}",
year = "2013",
month = "4",
day = "1",
doi = "10.1016/j.jcrc.2012.08.018",
language = "English",
volume = "28",
pages = "166--172",
journal = "Journal of Critical Care",
issn = "0883-9441",
publisher = "Elsevier BV",
number = "2",

}

TY - JOUR

T1 - Configuration of the Circle of Willis is associated with less symptomatic intracerebral hemorrhage in ischemic stroke patients treated with intravenous thrombolysis

AU - Chuang, Yu Ming

AU - Chan, Lung

AU - Lai, Yen Jun

AU - Kuo, Kuei Hong

AU - Chiou, Yih Hwa

AU - Huang, Lih Wen

AU - Kwok, Yam Ting

AU - Lai, Tzu Hsien

AU - Lee, Siu Pak

AU - Wu, Hung Ming

AU - Yeh, Yen Chi

PY - 2013/4/1

Y1 - 2013/4/1

N2 - Backgrounds: The circle of Willis (CoW) is a primary collateral pathway that compensates quickly for a drop in cerebral blood flow. Using the complete CoW as a surrogate marker for good collateral circulation, its prognostic value after intravenous thrombolysis was examined. Methods: We prospectively studied 64 consecutive patients with acute ischemic stroke treated with tissue plasminogen activator within 3 hours of stroke onset between October 2005 and June 2012 in our hospital. The study protocol was based on standard guidelines for intravenous thrombolysis. On computed tomographic angiography 24 hours after thrombolysis, the CoW was complete in 21 (32.8%) cases and incomplete in 43 (67.2%). Results: Patients with complete CoW were more likely to have early improvement in National Institute of Health Stroke Scale (NIHSS) score (median improvement 2 vs 0 at 2 hours; 4 vs 1 at 24 hours), be independent at 3 months (42% vs 19%). In the incomplete CoW group, the rate of symptomatic intracerebral haemorrhage (SICH) according to the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) definition was almost 3 times higher. Complete CoW was one of the strongest predictors of good functional outcome at 3 months (odds ratio 2.32; P = .01). Conclusions: Complete CoW independently predicted functional independence and survival.

AB - Backgrounds: The circle of Willis (CoW) is a primary collateral pathway that compensates quickly for a drop in cerebral blood flow. Using the complete CoW as a surrogate marker for good collateral circulation, its prognostic value after intravenous thrombolysis was examined. Methods: We prospectively studied 64 consecutive patients with acute ischemic stroke treated with tissue plasminogen activator within 3 hours of stroke onset between October 2005 and June 2012 in our hospital. The study protocol was based on standard guidelines for intravenous thrombolysis. On computed tomographic angiography 24 hours after thrombolysis, the CoW was complete in 21 (32.8%) cases and incomplete in 43 (67.2%). Results: Patients with complete CoW were more likely to have early improvement in National Institute of Health Stroke Scale (NIHSS) score (median improvement 2 vs 0 at 2 hours; 4 vs 1 at 24 hours), be independent at 3 months (42% vs 19%). In the incomplete CoW group, the rate of symptomatic intracerebral haemorrhage (SICH) according to the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) definition was almost 3 times higher. Complete CoW was one of the strongest predictors of good functional outcome at 3 months (odds ratio 2.32; P = .01). Conclusions: Complete CoW independently predicted functional independence and survival.

KW - Circle of Willis

KW - CT angiography

KW - Intravenous thrombolysis

KW - Symptomatic intracerebral haemorrhage

UR - http://www.scopus.com/inward/record.url?scp=84875406638&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84875406638&partnerID=8YFLogxK

U2 - 10.1016/j.jcrc.2012.08.018

DO - 10.1016/j.jcrc.2012.08.018

M3 - Article

VL - 28

SP - 166

EP - 172

JO - Journal of Critical Care

JF - Journal of Critical Care

SN - 0883-9441

IS - 2

ER -