ANATOMICAL VARIATIONS INFLUENCE STROKE PROGNOSIS AFTER THROMBECTOMY BACKGROUND: Changes in the normal anatomy of the circle of Willis may favour cerebrovascular disorders but how these conditions may influence stroke prognosis has not yet been studied. We aimed to analyse the influence of vessel anatomy on recanalization results and functional recovery in patients with stroke due to large vessel occlusion. METHODS: We performed a retrospective study of consecutive patients with middle cerebral artery (MCA) stroke undergoing endovascular treatment at our center. Anatomical variations of the circle of Willis were identified on baseline computed tomographic angiography. We assessed the dominance of either superior or inferior main divisions of the MCA and the M1/M2 angle (angle between distal M1 segment and proximal M2 segment) by digital subtraction angiography. We correlated these variables with radiological and clinical outcomes. RESULTS: N=190. Posterior communicating artery hypoplasia was the most common anomaly (50.5%) followed by the fetal origin of the posterior cerebral artery (fPCA) (23.2%). In a logistic regression model, patients with hypoplastic P1 segments were more likely to have a better collateral circulation (p<0.05), a lower 24-hour infarct volume (p<0.05) and better functional outcomes evaluated at 3-month mRS (p<0.01). In those patients with M1/M2 angles greater than 130º there was a trend towards fewer number of stent-retriever passes needed to complete recanalization (p=0.09). CONCLUSIONS: In our study, fPCA was found to be an independent predictor of better radiological and functional outcomes in patients with acute stroke. Other anatomical variations did not significantly influence the results of thrombectomy. We have not found any similar references in literature.
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