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• Clinical Article •
Correlation between Willis ring integrity and plaque characteristics and multiple infarctions in patients with acute ischemic stroke
WANG Zehua  GAO Yang  WU Qiong  HE Jinlong  ZHANG Qiang  HAO Xiangcheng  WANG Liwen 

DOI:10.12015/issn.1674-8034.2025.08.005.


[Abstract] Objective Based on high-resolution magnetic resonance vascular wall imaging analysis of Willis ring integrity, responsible plaque characteristics, infarct foci, and plaque numbers in patients with anterior circulation acute ischemic stroke, to explore the correlation between Willis ring integrity and plaque vulnerability, multiple infarctions, and plaque numbers.Materials and Methods Retrospective analysis of 85 patients with acute ischemic stroke in the anterior circulation who visited Our hospital from January 2022 to December 2023, all of whom underwent high-resolution magnetic resonance angiography within 14 days of symptom onset. And based on the integrity of the Willis ring, it was divided into two groups. Compare the clinical data and intracranial responsible plaque characteristics between two groups of anterior circulation and posterior circulation, respectively. Use Single factor and multiple factor binary logistic regression analysis to evaluate the correlation between Willis ring integrity and plaque coexistence, as well as multiple infarctions. Spearman and multiple linear regression analysis were used to evaluate the correlation between Willis loop integrity and plaque number, as well as enhancement level.Results The group with incomplete Willis anterior circulation had higher plaque burden (P = 0.001), enhancement rate (P = 0.043), greater stenosis of responsible vessels (P = 0.001), and more irregular plaque surfaces (P = 0.001). Compared with the intact symptom side group of the Willis loop, the incomplete symptom side group of the Willis loop had a higher plaque burden (P = 0.002), greater degree of responsible vessel stenosis (P = 0.001), and more irregular plaque surfaces (P = 0.013). Univariate logistic regression analysis showed that the incomplete anterior circulation of Willis ring was independently associated with multiple infarcts (OR = 2.94, 95% CI: 1.153 to 7.478, P = 0.024). Spearman analysis showed that the incomplete anterior circulation of Willis ring was positively correlated with the enhancement level (r = 0.321, P < 0.05); Another incomplete group was positively correlated with the number of plaques and the enhancement level (r = 0.358, 0.302; P < 0.05). Age, gender and clinical risk factors were adjusted, including smoking history, drinking history, hyperlipidemia, hypertension, and diabetes. The results of multiple logistic regression analysis showed that incomplete anterior circulation of Willis was independently associated with multiple infarctions (OR = 3.42, 95% CI: 1.208 to 9.700, P = 0.021). Multiple linear regression analysis showed that incomplete anterior circulation of Willis was a factor affecting the enhancement level (β = 0.571, P < 0.05), while incomplete posterior circulation of Willis was a factor affecting the number of plaques and enhancement level (β = 0.791, 0.341; P < 0.05).Conclusions Incomplete Willis ring will promote plaque vulnerability, multiple infarcts and atherosclerosis in multiple vascular beds. This indicates that the loss of integrity of the Willis ring may affect the hemodynamics of the extracranial and extracranial great arteries, thereby affecting the blood supply of brain tissue and atherosclerosis process.
[Keywords] acute ischemic stroke；multiple infarction；Willis ring；responsibility plaque；vascular wall imaging；magnetic resonance imaging

WANG Zehua   GAO Yang*   WU Qiong   HE Jinlong   ZHANG Qiang   HAO Xiangcheng   WANG Liwen  

Department of Radiology, the First Clinical Medical College of Inner Mongolia Medical University, Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China

Corresponding author: GAO Y, E-mail: 1390903990@qq.com

Conflicts of interest   None.

Received  2025-04-01
Accepted  2025-08-08
DOI: 10.12015/issn.1674-8034.2025.08.005
DOI:10.12015/issn.1674-8034.2025.08.005.

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