PMC:7305584 / 10927-18442 JSONTXT

{"target":"http://pubannotation.org/docs/sourcedb/PMC/sourceid/7305584","sourcedb":"PMC","sourceid":"7305584","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7305584","text":"Results\n\nVascular anatomy\nThe demographic data of the subjects are summarized in Table 1. All 210 subjects were asymptomatic Han-Chinese adults, and only 81 (38.6%) had complete symmetric of the COW. Seven subjects with bilateral F-PCAs and symmetric A1s were not included in the symmetric group due to a lack of bilateral P1 segments. Sixty-seven subjects had asymmetric A1 segments (31.9% of all cases), including 19 (9%; AA1 group) with unilateral A1 aplasia, 33 (15.7%; AA2 group) with ≥50% A1 asymmetry, and 15 (7.1%; AA3 group) with \u003c 50% A1 asymmetry.\nTable 1 Subjects demographic data by Circle of Willis variants\nAll Symmetrica A1 Asymmetry (AA group)b PcomA Asymmetry (PA group)c\nAA1 AA2 AA3 P-value PA1d PA2 PA3 P-value\nNumber of cases 210 81 (38.6%) 19 (9%) 33 (15.7%) 15 (7.1%) 15 (7.1%) 45 (21.4%) 18 (8.6%)\nAge (years) 53.9 ± 9.4 50.4 ± 9.3 52.6 ± 11.5 54.6 ± 10.1 49.9 ± 8.3 0.344 55.4 ± 7.9 53.3 ± 9.5 51.8 ± 7.0 0.507\nRight-side 6 (31.6%) 8 (24.2%) 7 (46.7%) 0.311 10 (66.7%) 29 (64.4%) 14 (77.8%) 0.588\nSex\n Female 77 (36.7%) 32 (39.5%) 7 (36.8%) 8 (24.2%) 4 (26.7%) 0.601 7 (46.7%) 15 (33.3%) 10 (55.6%) 0.262\n Male 133 (63.3%) 49 (60.5%) 12 (63.2%) 25 (75.8%) 11 (73.3%) 8 (53.3%) 30 (66.7%) 8 (44.4%)\nHeight (cm) 165.2 ± 8.1 165.2 ± 8.7 166.7 ± 8.2 165.5 ± 6.6 166.1 ± 6.1 0.841 163.3 ± 7.8 165.6 ± 8.7 163.4 ± 7.6 0.494\nWeight (Kg) 68.0 ± 13.2 69.6 ± 14.6 69.4 ± 13.7 65.8 ± 9.9 69.7 ± 13.7 0.428 64.9 ± 11.4 67.9 ± 13.5 64.5 ± 11.0 0.543\nHeart rate (/min) 67.3 ± 10.0 66.8 ± 11.1 65.8 ± 10.4 68.3 ± 8.0 65.5 ±12.6 0.551 67.8 ± 8.2 68.4 ± 7.9 69.7 ± 12/0 0.820\naSeven subjects with bilateral F-PCAs were excluded\nbTwenty-three patients in the AA group had PcomA asymmetry, including 2 PA1, 14 PA2, and 7 PA3\ncTwenty-three patients in the PA group had A1 asymmetry, including 5 AA1, 13 AA2, and 5 AA3\ndThirty-seven subjects with 45 F-PCA, with 20 right-side F-PCA, 9 left-side F-PCA, and 8 bilateral F-PCAs\nSeventy-eight subjects (37.1% of all cases) were included in the PA group, including 15 in the PA1 group (7.1%) with a unilateral F-PCA and absent contralateral PcomAA, 45 in the PA2 group (21.4%) with ≥50% PcomA asymmetry, and 18 in the PA3 group (8.6%) with \u003c 50% PcomA asymmetry. Twenty-three subjects had both A1 and PcomA asymmetry. In these subjects, the dominant A1 was most likely to be on the same side as the non-dominant PcomA (19 patients, P \u003c 0.001, McNemar’s test). Only 4 subjects had the dominant A1 and dominant PcomA on the same side.\n\nComparison of vessel diameters and flow in different subgroups\n\nAA group\nWhen ACA asymmetry was present, there were significant differences in ICA diameter between dominant and non-dominant sides in the AA1, AA2, and AA3 groups (Fig. 3a). Compared with the symmetric group, the AA1 and AA2 groups had a significantly larger ICA diameter on the dominant side and a significantly smaller ICA diameter on the non-dominant side. Similarly, significant differences in bilateral ICA flow were also found in the AA1 and AA2 groups (Fig. 3b). The average bilateral ICA flow volume difference percentages of the AA1, AA2, and AA3 groups were 42.9, 30.7, and 29%, respectively (Table 2). A greater asymmetry between the bilateral A1 segments tended to be associated with a larger difference between the bilateral ICA flow volume.\nFig. 3 Vessel diameter and flow in each group of COW variants. (a) Diameter and (b) Flow volume of the non-dominant and dominant ICAs in the different AA groups; (c) Diameter and (d) Flow volume of the non-dominant and dominant ICAs in the different PA groups; (e) Diameter and (f) Flow volume of the non-dominant and dominant ICAs in different PA groups without A1 asymmetry.* Significant difference between non-dominant and dominant ICA in a certain subgroup (P \u003c 0.05). # Significant difference between non-dominant ICA of a certain subgroup and ICA of the symmetric subgroup (P \u003c 0.05). \u0026 Significant difference between dominant ICA of a certain subgroup and ICA of the symmetric subgroup (P \u003c 0.05). The cover bar indicates a significant difference between different COW subgroups. (P \u003c 0.05)\nTable 2 ICA flow and diameter parameters for each group of COW variants\nAll Symmetric A1 Asymmetry (AA group) PcomA Asymmetry (PA group)\nAA1 AA2 AA3 Non-AA Pvalue PA1 PA2 PA3 Non-PA Pvalue\nNumber of subjects 210 81 (38.6%) 19 (9%) 33 (15.7%) 15 (7.1%) 143 (68.1%) 15 (7.1%) 45 (21.4%) 18 (8.6%) 132 (62.9%)\nICA-PDF 6.9 ± 16.6 −0.1 ± 7.9 30.8 ± 22.4 17.4 ± 20.3 9.5 ± 16.4 1.0 ± 9.1 \u003c 0.0001 7.3 ± 14.8 6.2 ± 13.3 7.3 ± 22.5 7.0 ± 17.0 0.993\nICA diameter difference (mm) 0.37 ± 0.32 0.22 ± 0.22 0.76 ± 0.33 0.55 ± 0.38 0.48 ± 0.38 0.26 ± 0.22 \u003c 0.0001 0.40 ± 0.29 0.41 ± 0.34 0.40 ± 0.37 0.34 ± 0.31 0.655\nICA flow difference (ml/min) 65.9 ± 51.6 51.0 ± 38.8 124.6 ± 73.2 76.9 ± 45.8 76.2 ± 62.2 54.6 ± 42.0 \u003c 0.0001 65.1 ± 47.3 64.0 ± 54.2 72.9 ± 53.4 65.6 ± 51.5 0.943\nICA flow difference percentage (%) 24.5 ± 17.8 19.6 ± 14.3 42.9 ± 24.1 30.7 ± 18.6 29.0 ± 19.0 20.2 ± 14.2 \u003c 0.0001 25.0 ± 14.9 22.5 ± 16.0 25.5 ± 18.0 25.1 ± 18.7 0.852\n\nPA group \u0026 F-PCA\nA significant difference in bilateral ICA diameter and flow was only found in the PA1 group with unilateral F-PCA and no contralateral PcomA. If an F-PCA was present, there was a trend for the ipsilateral ICA to have a larger diameter and higher flow volume as compared with the symmetric group (Fig. 3c, d). However, there was no significant difference between these 2 groups concerning diameter (P = 0.059) and flow volume (P = 0.085). On the other hand, the difference between ICA flow ipsilateral to the F-PCA and in the symmetric group reached statistical significance (P = 0.049) after the exclusion of 15 patients with an F-PCA with concomitant A1 asymmetry (Fig. 3e, f).\n\nAssociation of ICA diameter with ICA flow\nA moderately positive linear correlation between ICA diameter and ICA flow in the AA group (R2 = 0.238) was noted (Fig. 4a) According to the linear equation, there was a 62.6 ml increase in the ICA flow volume per 1 mm increase in the ICA diameter. Based on the average ICA flow volume of 265.9 ml/min in the AA group, it implied a change of 23.5% of the ICA flow volume per 1 mm change in the ICA diameter. On the other hand, no significant association was noted between ICA diameter and flow volume in either the PA (Fig. 4b) and symmetric groups (Fig. 4c). Carotid diameter and flow differences for each group of COW variants are shown in Table 2. All parameters, including ICA diameter difference, ICA flow difference, ICA flow difference percentage, and product of bilateral ICA diameter and flow difference (ICA-PDF) of each AA group exhibited significant differences. Among them, ICA-PDF had the highest area under the ROC curve (AUC = 0.807) for discriminating the AA1 and AA2 groups from the others, followed by ICA diameter difference (AUC = 0.771), ICA flow difference percentage (AUC = 0.703), and ICA flow difference (AUC = 0.695) (Fig. 5a). For the prediction of A1 absence, ICA-PDF and ICA-diameter difference exhibited even higher accuracy for discriminating the AA1 group from the other groups (Fig. 5b). The optimal cutoff value for bilateral A1 asymmetry ≥50% was a PDF = 4.31 with a sensitivity of 0.81 and specificity of 0.76.\nFig. 4 Linear regression analysis of ICA diameter and ICA flow in each group of COW variants. (a) AA group, (b) PA group, and (c) symmetric group\nFig. 5 ROC curve of all parameters of ICA diameter and flow difference of different AA groups. 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