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(Stroke. 2000;31:1913.)
© 2000 American Heart Association, Inc.

Original Contributions

A Longitudinal Study of Collateral Flow Patterns in the Circle of Willis and the Ophthalmic Artery in Patients With a Symptomatic Internal Carotid Artery Occlusion

D. R. Rutgers, MD; C. J. M. Klijn, MD; L. J. Kappelle, MD; A. C. van Huffelen, MD J. van der Grond, PhD

From the Departments of Radiology (D.R.R., J. van der G.), Neurology (C.J.M.K., L.J.K.) and Clinical Neurophysiology (A.C. van H.), University Medical Center Utrecht, the Netherlands. (The UMC Utrecht consists of the University Hospital Utrecht, the Medical Faculty Utrecht, and the Wilhelmina Children’s Hospital.)

Correspondence to D.R. Rutgers, MD, Department of Radiology, E01.132, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands. E-mail: D.Rutgers{at}azu.nl

Background and Purpose—The purpose of the present study was to assess whether the direction of flow via the circle of Willis and the ophthalmic artery (OphA) changed over time in patients with a symptomatic occlusion of the internal carotid artery (ICA) who did not experience recurrent cerebral ischemic symptoms.

Methods—Sixty-two patients with a symptomatic ICA occlusion were investigated within 6 months after symptoms occurred. The investigations were repeated after 6 and 12 months. The directions of flow in the A1 segment and the posterior communicating artery (PCoA), both on the side of the symptomatic ICA occlusion, were assessed with the use of magnetic resonance angiography. The pattern of collateral flow via the circle of Willis was categorized as via the A1 segment only, via the PCoA only, via the A1 segment plus the PCoA, or no collateral flow via the circle of Willis. The direction of flow in the OphA was investigated with transcranial Doppler sonography. CO₂ reactivity was determined with transcranial Doppler sonography to investigate whether changes in flow patterns were accompanied by changes in cerebrovascular reactivity.

Results—There were no statistically significant changes over time in the direction of blood flow in the A1 segment and the PCoA or in the pattern of collateral flow via the circle of Willis. On average, 72% of patients with a unilateral ICA occlusion (n=41) had willisian collateral flow compared with 37% of patients with a bilateral ICA occlusion (n=21; P<0.05). Patients with a unilateral ICA occlusion tended to a lower prevalence of reversed flow via the OphA over time. CO₂ reactivity did not change significantly in any patient group. In patients with a unilateral ICA occlusion, decreased CO₂ reactivity was associated with a higher prevalence of absent willisian collateral flow and a lower prevalence of collateral flow via the A1 segment plus the PCoA.

Conclusions—The absence of recurrent cerebral ischemic symptoms in patients with a symptomatic ICA occlusion is not associated with an improvement in collateral flow via the circle of Willis or the OphA during 1.5-year follow-up.

Key Words: carotid artery occlusion • collateral circulation • follow-up studies

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