Influence of the integrity of circle of Willis on asymptomatic or mild patients with first diagnosed chronic internal carotid artery occlusion

In order to identify individuals with chronic internal carotid artery occlusion (CICAO), it is essential to understand the integrity of the circle of Willis (CoW). This understanding is important as it may determine the potential benefits of active medical and endovascular treatments.The objective of this study is to assess whether diminished integrity of the CoW can serve as a useful marker for identifying individuals with more severe impairment in cerebral blood perfusion and a higher incidence of cerebral infarction among asymptomatic or mildly affected patients with CICAO.We conducted a retrospective review of asymptomatic or mildly affected patients with newly diagnosed CICAO who did not receive reperfusion therapies. The categorization of patients into good or poor integrity groups was based on the assessment of CoW integrity using CTA. We evaluated the volume and value of prolonged time to peak (TTP) in both groups, as well as the occurrence of new cerebral infarctions. Our analysis involved multivariate regression and receiver operating characteristic (ROC) analysis.Hemodynamic abnormalities characterized by prolonged TTP were observed in the affected side's blood supply region in all 38 patients. There was a notable difference in the volume and value of prolonged TTP between the two groups (P < 0.001). Correlation analyses based on CTP and CTA parameters revealed a negative relationship between CoW scores and both the abnormal volume (r = -0.624, P = 0.000) and value (r = -0.589, P = 0.000) of prolonged TTP. Upon multivariable adjustment, the independent predictors for new cerebral infarction and higher volume of prolonged TTP were solely the CoW status, with respective estimates of (b = 6.05; 95% confidence interval [CI]: 1.619, 22.619; P = 0.007) and (b = 35.486; 95% CI: 4.697, 268.088; P = 0.001).Assessing the integrity of the CoW is crucial in evaluating abnormal perfusion in asymptomatic or mildly affected individuals who are newly diagnosed with CICAO and have not undergone reperfusion therapy.